Ankle impingement after extra-articular open fracture of the leg: Full arthroscopic treatment in the supine position

•Ankle impingement is a late complication of extra-articular open fracture of the leg that is often underestimated.•We propose an operative strategy to treat anterior and posterior ankle impingement after extra-articular open fracture of the leg.•Anterior ankle impingements were treated by anterior...

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Bibliographic Details
Published in:Injury 2024-06, Vol.55, p.111356, Article 111356
Main Authors: Ilie, Vlad I., Thoreux, Patricia, Bégué, Thierry, Villain, Benoit, Levante, Stéphane, Aurégan, Jean Charles
Format: Article
Language:English
Subjects:
Ankle arthroscopy
Ankle impingement
Extra-articular leg fracture
Open fracture
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Summary:•Ankle impingement is a late complication of extra-articular open fracture of the leg that is often underestimated.•We propose an operative strategy to treat anterior and posterior ankle impingement after extra-articular open fracture of the leg.•Anterior ankle impingements were treated by anterior arthroscopy in supine position.•Anterior and posterior impingements were treated by anterior and posterior arthroscopy in supine position.•Anterior and posterior impingements associated with retraction of gastrocnemius muscles were treated with anterior arthroscopy in supine position followed by posterior arthroscopy in prone position, and an open tendon lengthening of the calcaneal tendon in the same position. Extra-articular open fractures of the leg often result from high energy trauma. After healing, a painful ankle impingement may occur. In the event of anterior and posterior impingements, arthroscopic treatment may require two surgical positions. We propose an operative strategy to treat anterior and posterior ankle impingement after extra-articular open fracture of the leg. Our hypothesis is that this strategy is simple, effective and with a low risk of complication. Anterior ankle impingements were treated by anterior arthroscopy in supine position; anterior and posterior impingements were treated by anterior and posterior arthroscopy in supine position; anterior and posterior impingements associated with retraction of gastrocnemius muscles were treated with anterior arthroscopy in supine position followed by posterior arthroscopy in prone position, and an open tendon lengthening of the calcaneal tendon in the same position. The anterior and posterior arthroscopic release was tested in the cadaver laboratory. Then, the surgical strategy was applied to our patients in our clinical practice. After, we analysed retrospectively the results of the strategy in the first patients treated for a painful ankle impingement after extra-articular open fracture of the leg. The data retrieved were the importance of pain (VAS), the presence of clinical instability, ankle mobility, gastrocnemius retraction and the AOFAS functional score and the post-operative complications. Then, these data were compared before the surgery and at last follow-up. From the cadaver laboratory, anterior and posterior arthroscopic release was possible in all cases without changing position. From our clinical practice, we included 5 patients (3 women and 2 men, mean age 43 years) suffering fro
ISSN:0020-1383
1879-0267
1879-0267
DOI:10.1016/j.injury.2024.111356