Talar Osteochondral Lesions With Pilon Fractures

Previous studies have demonstrated a high incidence of talus osteochondral lesions (OCLs) associated with rotational ankle fractures, with rates reported as high as 45%. Consequently, an increasing number of surgeons have employed ankle arthroscopy at the time of fixation to evaluate and manage potential OCLs.

To date, no studies have assessed the incidence of talus OCLs associated with high-energy tibial plafond (pilon) fractures. Ankle arthroscopy at the time of definitive fixation for pilon fractures is often contraindicated due to significant soft tissue swelling and the risk of wound complications. However, if concurrent OCLs could be identified at the time of temporizing external fixation using nano-arthroscopy, such findings could inform surgical planning, including modifications to approach, staging, or definitive management.

Patients will be identified through a treating relationship to the patient when they present for management of their injury. Written consent for the arthroscopy portion, photos, sample collection will be performed while they are in the hospital before surgery, or at the same time they are consented for surgery.

The goal of the study is to enroll 25 participants.

Study Procedures

1. Operative Phase Eligible patients will be identified and consented for external fixation and possible diagnostic ankle nano-arthroscopy. During the external fixation procedure, following frame placement, the Arthrex Nanoscope will be introduced into the tibiotalar joint to evaluate for osteochondral lesions. Lesions will be documented regarding presence (yes/no), location, and size. 2. Imaging Phase (with blinding) Postoperative computed tomography (CT) scans will be obtained as part of standard preoperative planning for definitive fixation. A blinded surgeon (unaware of arthroscopy findings) will review the CT scans to assess for possible OCLs. Comparison between CT and arthroscopic findings will determine the incremental diagnostic value of nano-arthroscopy. 3. Surgeon Decision-Making Analysis

After 25 patients are evaluated, six fellowship-trained orthopedic trauma or foot \& ankle surgeons will independently review patient histories, radiographs, and CTs to develop a preoperative plan. They will then be shown the same cases with knowledge of OCL findings to determine whether this information alters their management strategy. Possible management modifications include: * Open reduction internal fixation (ORIF) with microfracture * ORIF with graftnet or biocartilage treatment * ORIF with allograft plug * ORIF with staged bulk allograft talus * Acute tibiotalar fusion * Acute total ankle arthroplasty 4. Synovial Fluid analysis from fluid collected at time of arthroscopy. 5. Tracking of outcomes and complications through standard of care follow-up.