Unsatisfactory outcome following surgical intervention of ankle fractures

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Abstract

The aim of this study was to evaluate outcome after surgical intervention in patients with ankle fractures. Fifty-four patients consecutively operated were included. A standardised protocol was used to record a number of variables regarding patient characteristics, type of fracture and treatment. Radiographic examination was performed in all patients postoperatively and after 14 months. A questionnaire containing the Olerud–Molander Ankle Score (OMAS) and some supplementary questions was used 14 months and 3 years after surgery. The median OMAS was 75 at the 14-month and 85 at the 3-year follow-up. Patients <40 years of age scored significantly better. Only 50% returned to the same activity level 14 months after injury. Pain, stiffness and swelling were present among more than half of the patients and 40% reported instability and problems when using stairs. In conclusion, subjective outcome 3 years after surgical intervention for ankle fractures is poorer than expected.

Introduction

Fractures involving the ankle are increasing [1], [2], [3] and are among the most common injuries of the lower extremity with an incidence of 107 fractures per 105 person-years [4]. The treatment recommended for displaced ankle fractures is open reduction and internal fixation [5], [6]. Patients with primary clinically severely dislocated ankle joints have been reported to have significantly more complaints [7]. Adequate reduction with congruency of the joint has been reported as one of the most important predictors of a good end result [8], [9], [10], [11], [12], [13], [14]. Inadequate reduction may lead to osteoarthritis, which is also important for subjective outcome [8], [10], [11], [12]. Some studies have reported only slight disability after surgically treated ankle fractures [15], [16], [17], [18], [19]. However, long-term results after bimalleolar fracture have been found in a later published study to be poorer than has been previously described [20].

The Olerud–Molander Ankle Score (OMAS) has been frequently used to evaluate subjectively scored function after ankle fracture [11], [12], [15], [17]. The score is validated against (a) linear analogue scale (LAS) measuring subjective recovery, (b) range of motion in loaded dorsal extension, (c) presence of osteoarthritis and (d) presence of dislocations on radiographs, and it has been found to correlate well with these four parameters [11].

The purpose of this study was to evaluate self-reported symptoms and functional limitation 1 and 3 years after surgical intervention in patients with ankle fractures using the Olerud–Molander Ankle Score and some supplementary questions.

Section snippets

Patients and study design

All patients, 17–64 years, who lived within a demarcated region covered by Lund University Hospital, Sweden, and who were operated on because of an ankle fracture during a ten-month period were included (n=67). Five patients were excluded as they suffered from other diseases that might affect the function of the lower extremity, such as neurological disease (n=2), another fracture in the lower extremity (n=2) and arthritis (n=1). A standardised protocol was used to record a number of variables

Radiological examination at 14 months

At the 14-month follow-up all fractures were healed, in 40 cases with no displacement and in 11 with slight displacement. Compared to the first postoperative radiographic examination one new patient had developed slight displacement (<2 mm). In the other cases the displacement had not changed between the first postoperative radiographic examination and the one at the 14-month follow-up. Neither age nor gender related to reduction results. Fractures with bimalleolar internal fixation more

Discussion

It is commonly believed that the outcome following surgical intervention after ankle fractures is quite good [15], [16], [17], [18], [19]. However, long-term results have been found to be poorer than has previously been described. Day et al. [20] reported only 52% having good results and Lash et al. [25] found that patients could be expected to experience functional difficulties two years after fracture. In the present study, we found that 3 years after the injury more than half of the patients

Acknowledgements

We would like to thank all the subjects who volunteered for this study, Per Nyberg, PhD, for statistical advice and the Skåne County Council, Primary Care Research for financial support.

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