Is arthroscopically-assisted reduction and internal fixation (ARIF) superior to percutaneous fixation in talar neck fractures? A proportional meta-analysis

INTRODUCTION: Arthroscopically assisted Reduction and Internal Fixation (ARIF) to fix talar neck fractures is progressively gaining popularity. Our aim was to determine if ARIF in this setting might increase the healing rate and reduce the number of complications as compared to percutaneous fixation (PF) alone. METHODS: As per PRISMA guidelines, multiple databases (Scopus, Pubmed, Web of Science and Cochrane) were used to retrieve studies reporting on patients diagnosed with a fracture of the talar neck undergone minimally invasive surgery using screws as exclusive fixation method. Data were recorded regarding the design of the study, the cohort, the surgical technique and the outcome achieved (clinical scores and complication rate) with the longest possible follow-up. The methodological quality of studies was evaluated using the MINORS (methodological items for non-randomized studies). Results after ARIF and PF were compared. RESULTS: Six studies were selected (ARIF=11 cases, 2 studies; PF=51 cases, 4 studies). In the two groups, the mean sample size (p = 0.88) and the mean age of patients (p = 0.24) were comparable. Patients were mostly males in the percutaneous fixation group (M/F: 36/15) and mostly females in the ARIF group (M/F: 4/7). The mean follow-up in the ARIF group was 16 months (range, 12-18) and 31 months in the percutaneous fixation group (range, 20-48), but the difference was not significant (p = 0.09). In both groups radiographic healing was achieved in all patients. The pooled complication rate was significantly different in the ARIF group (1 %) as compared to the PF group (19 %; p = 0.04). The incidence of early (before 48 months) peri-talar osteoarthritis was significantly lower in ARIF (0 %) as compared to PF (11 %; p = 0.04). The quality of studies was poor in the ARIF group and moderate in the PF group. CONCLUSIONS: In this review based on small-sample studies, we found a similar radiographic healing rate in talar neck fractures treated percutaneously using screws with or without arthroscopy. Arthroscopic assistance allowed to reduce the incidence of complications, and specifically of early (before 48 months) peri-talar osteoarthritis. Larger studies are needed to confirm or disprove these findings. LEVEL OF EVIDENCE: level IV, systematic review of level I to IV studies.