I wanna say thank you very much to both societies and all of you for the opportunity to present the research. Really appreciate it. So I have nothing to disclose. So ankle fractures remain a common orthopedic problem that often requires surgical intervention and are likely to continue to remain a problem in the future. And despite anatomic reduction, surgical fixation, healing, a certain substance of these patients still experience poor long-term results, certainly poorer than we would expect. We know that with trauma, there's often concomitant chondral lesions that occur. And chondral lesions are an independent risk factor for osteoarthritis progression. So not widely used at this point, ankle arthroscopy in the setting of all ankle fractures. We do know that it has the potential to increase the detection of these occult intra-articular pathologies. But in the literature, if you look, the degree of visualization that's afforded by arthroscopy versus open visualization alone through fracture fragments is not well described. And so the purpose of this study was simple and small in scope. It was to try and quantify the degree of visualization of the talus that could be obtained through the fracture fragments of an SCR-type ankle fracture. And so our methods, we used two fresh frozen cadaveric specimens. We excluded them if they had any history of deformity or surgical intervention that was evidenced by scar. One fellowship-trained foot and ankle surgeon performed medial and lateral approaches. We then used an osteotome to recreate a Loggi-Hansen supination external rotation ankle fracture. And then separated the fragments using a laminar spreader or self-retainer, removed all the available cartilage utilizing plantar and dorsiflexion to obtain the maximal visualization of the talus. We then exhumed the tali, dyed those areas with surgical marker for easier visualization, measured those, and compared those as a percentage of the total weight-bearing surface of the talus. And so our results, you can see there's a wide range from the small sample size from 7.6% visualization available to talus all the way up to 20. It averages out to about 14.8% of the talus that's visible through that wide approach that you just saw. And so what does this tell us? We know that if you look at all comers with osteoarthritis, that 70% of these patients in the literature have some sort of history of trauma to this joint. We also know that ankle cartilage is unique. So Ramsey and Hamilton back in 1976 described that one millimeter of lateral translation decreases your contact area by 42% and drastically increases your contact forces, which can lead to predisposition for osteoarthritis progression. We also know that biomechanically, the cartilage there is smaller in depth and relies on that congruency more than even the hip or the knee to prevent progression of osteoarthritis. So prior work has also demonstrated that intra-articular occult cartilage lesions can happen as high as 65% of the time in some literature with ankle fractures. And these lesions can lead to impaired function, limited motion, stiffness, catching, locking, and or swelling and ankle joint pain. And this study suggests that you can see approximately 15% of the talus, leaving about 85% of the talus inaccessible and unvisualized. So what does this tell us? Well, the weight bearing portion of the talus surface that's visible through your fracture fragments with an open exposure may be less than many surgeons have historically postulated or thought. And ankle arthroscopy may be a useful adjunct to completely visualize concurrent chondal pathology to document and or treat that could affect the patient's functional outcomes. Thank you very much.

ankle fractures

surgery

chondral lesions

osteoarthritis progression

ankle arthroscopy