In recent years, arthroscopic surgery of the ankle has become a standard orthopedic and trauma care procedure and can be used to address a wide range of injuries and pathologies. Acute injuries such as joint fractures, syndesmosis ruptures, acute osteochondral fractures, and ligament ruptures as well as chronic pathologies like impingement, stiff joints, chronic ligament ruptures, and osteochondral lesions can now be treated with arthroscopic surgery or arthroscopy-assisted procedures.
Fractures of the ankle and the tarsus are common injuries that can result from a sports or work-related accident. The ankle joint is most commonly affected, though all parts of the ankle are at risk (outer ankle, inner ankle, rear edge of the tibia—sometimes called the Volkmann triangle). Depending on the type of fracture, patient’s age, and level of activity, a personalized treatment decision will be made either for conservative therapy via immobilization in a plaster cast or Walker boot, or surgical treatment via arthroscopy, open repositioning, and fixation using titanium screws or plates. It is not uncommon to encounter a combined injury with a ligament rupture or syndesmosis rupture, which can be stabilized with sutures or an anchor and a tight rope system in the same treatment session. In some instances, the magnitude of the impact can also affect the top of the ankle in a pilon fracture. Such fractures often involve badly shattered bones, which must be delicately reconstructed to prevent osteoarthritis from developing. A bone transplant using material from the patient’s own or donated bone matter, or bone substitute material, can often be necessary to provide a good support surface for the joint. In the case of cartilage defects, a chondrogenic matrix may be required to achieve regeneration. Fractures of the tarsal bones, such as the talus or heel bone, very often affect one or more joints and must be treated surgically, even if only slightly displaced, in order to avoid long-term consequences. Titanium screws are often used for this, and in some cases, such as complex calcaneal fractures, the bone must be reconstructed and firmly fixed by titanium plates. It is important to achieve a level of training stability that is sufficient to prevent post-traumatic joint stiffness. Metatarsal and toe fractures can often be treated conservatively. In some cases, however—for example when there is severe shortening, axial deviation, or rotational misalignment—screws and plates must be surgically implanted. A Jones fracture at the base of the fifth metatarsal is a special case. Due to the critical blood flow around the fracture area, conservative treatment cannot always guarantee adequate healing, and the subsequent development of pseudarthrosis is not uncommon. Accordingly, this type of fracture should be treated using screws.
After the bone has healed, the implants can be removed in a later operation if any mechanical irritation is present. However, removal is no longer the general recommendation, and cases must be considered on an individual basis.
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