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Long-term functional and radiographic outcomes in 243 operated ankle fractures.

Verhage SM, Schipper IB, Hoogendoorn JM - J Foot Ankle Res (2015)

Bottom Line: In addition, no functional differences were found between bimalleolar and trimalleolar fractures.Surprisingly, poor outcomes were found for isolated medial malleolar fractures.The results of our study show that long-term functional outcome is strongly associated to medial malleolar fractures, isolated or as part of bi- or trimalleolar fractures.

View Article: PubMed Central - PubMed

Affiliation: MC Haaglanden, Department of Surgery, Postbus 432, 2501 CK The Hague, The Netherlands.

ABSTRACT

Background: Large comparative studies that have evaluated long-term functional outcome of operatively treated ankle fractures are lacking. This study was performed to analyse the influence of several combinations of malleolar fractures on long-term functional outcome and development of osteoarthritis.

Methods: Retrospective cohort-study on operated (1995-2007) malleolar fractures. Results were assessed with use of the AAOS- and AOFAS-questionnaires, VAS-pain score, dorsiflexion restriction (range of motion) and osteoarthritis. Categorisation was determined using the number of malleoli involved.

Results: 243 participants with a mean follow-up of 9.6 years were included. Significant differences for all outcomes were found between unimalleolar (isolated fibular) and bimalleolar (a combination of fibular and medial) fractures (AOFAS 97 vs 91, p = 0.035; AAOS 97 vs 90, p = 0.026; dorsiflexion restriction 2.8° vs 6.7°, p = 0.003). Outcomes after fibular fractures with an additional posterior fragment were similar to isolated fibular fractures. However, significant differences were found between unimalleolar and trimalleolar (a combination of lateral, medial and posterior) fractures (AOFAS 97 vs 88, p < 0.001; AAOS 97 vs 90, p = 0.003; VAS-pain 1.1 vs 2.3 p < 0.001; dorsiflexion restriction 2.9° vs 6.9°, p < 0.001). There was no significant difference in isolated fibular fractures with or without additional deltoid ligament injury. In addition, no functional differences were found between bimalleolar and trimalleolar fractures. Surprisingly, poor outcomes were found for isolated medial malleolar fractures. Development of osteoarthritis occurred mainly in trimalleolar fractures with a posterior fragment larger than 5 %.

Conclusions: The results of our study show that long-term functional outcome is strongly associated to medial malleolar fractures, isolated or as part of bi- or trimalleolar fractures. More cases of osteoarthritis are found in trimalleolar fractures.

No MeSH data available.


Related in: MedlinePlus

Calculation of size of the posterior fragment
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Related In: Results  -  Collection


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Fig1: Calculation of size of the posterior fragment

Mentions: All initial radiographs were grouped according to the AO and Lauge-Hansen [11] classifications by two independent observers. In addition, we grouped all fractures on the basis of the initial x-ray into the following groups based on the location and number of fractures: isolated fibular fracture (F), fibular fracture with additional posterior fracture (FP), isolated medial fracture (M), bimalleolar (combination of fibular and medial) fracture (FM) or trimalleolar fracture if a lateral, medial and posterior fracture were present (T). Dislocation of the fragments, congruency of the joint space, medial clear space in isolated fibular fractures, and the size of the posterior fragment in cases of involvement of the posterior malleolus were measured both on preoperative and postoperative X-rays. Medial clear space was measured on the mortise view as the distance between the lateral border of the medial malleolus and the medial border of the talus. A space greater than 4 mm was considered as abnormal because it indicates a lateral shift of the talus due to deltoid ligamentous injury leading to incongruency of the ankle joint [12]. The indication for surgical intervention in isolated fibular fractures without deltoid ligament injury was dislocation ≥ 2 mm of the fragments. Evaluation of syndesmotic widening was performed by measuring the distance between the medial wall of the fibula and the incisural surface of the tibia, which should be less than 6 mm both on AP and mortise views [12]. Size of posterior fragment was defined as the length of the joint-involved part of the posterior fragment divided by the total length of the joint surface in anterior-posterior direction (Fig. 1). All participants were treated surgically and fixation took place according to AO principles. Large posterior fragments were reduced closed or percutaneously and fixed by anterior-posterior placement of 1 or 2 screws under fluoroscopic control. Type of surgery depended on preference of the attending surgeon.Fig. 1


Long-term functional and radiographic outcomes in 243 operated ankle fractures.

Verhage SM, Schipper IB, Hoogendoorn JM - J Foot Ankle Res (2015)

Calculation of size of the posterior fragment
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4548913&req=5

Fig1: Calculation of size of the posterior fragment
Mentions: All initial radiographs were grouped according to the AO and Lauge-Hansen [11] classifications by two independent observers. In addition, we grouped all fractures on the basis of the initial x-ray into the following groups based on the location and number of fractures: isolated fibular fracture (F), fibular fracture with additional posterior fracture (FP), isolated medial fracture (M), bimalleolar (combination of fibular and medial) fracture (FM) or trimalleolar fracture if a lateral, medial and posterior fracture were present (T). Dislocation of the fragments, congruency of the joint space, medial clear space in isolated fibular fractures, and the size of the posterior fragment in cases of involvement of the posterior malleolus were measured both on preoperative and postoperative X-rays. Medial clear space was measured on the mortise view as the distance between the lateral border of the medial malleolus and the medial border of the talus. A space greater than 4 mm was considered as abnormal because it indicates a lateral shift of the talus due to deltoid ligamentous injury leading to incongruency of the ankle joint [12]. The indication for surgical intervention in isolated fibular fractures without deltoid ligament injury was dislocation ≥ 2 mm of the fragments. Evaluation of syndesmotic widening was performed by measuring the distance between the medial wall of the fibula and the incisural surface of the tibia, which should be less than 6 mm both on AP and mortise views [12]. Size of posterior fragment was defined as the length of the joint-involved part of the posterior fragment divided by the total length of the joint surface in anterior-posterior direction (Fig. 1). All participants were treated surgically and fixation took place according to AO principles. Large posterior fragments were reduced closed or percutaneously and fixed by anterior-posterior placement of 1 or 2 screws under fluoroscopic control. Type of surgery depended on preference of the attending surgeon.Fig. 1

Bottom Line: In addition, no functional differences were found between bimalleolar and trimalleolar fractures.Surprisingly, poor outcomes were found for isolated medial malleolar fractures.The results of our study show that long-term functional outcome is strongly associated to medial malleolar fractures, isolated or as part of bi- or trimalleolar fractures.

View Article: PubMed Central - PubMed

Affiliation: MC Haaglanden, Department of Surgery, Postbus 432, 2501 CK The Hague, The Netherlands.

ABSTRACT

Background: Large comparative studies that have evaluated long-term functional outcome of operatively treated ankle fractures are lacking. This study was performed to analyse the influence of several combinations of malleolar fractures on long-term functional outcome and development of osteoarthritis.

Methods: Retrospective cohort-study on operated (1995-2007) malleolar fractures. Results were assessed with use of the AAOS- and AOFAS-questionnaires, VAS-pain score, dorsiflexion restriction (range of motion) and osteoarthritis. Categorisation was determined using the number of malleoli involved.

Results: 243 participants with a mean follow-up of 9.6 years were included. Significant differences for all outcomes were found between unimalleolar (isolated fibular) and bimalleolar (a combination of fibular and medial) fractures (AOFAS 97 vs 91, p = 0.035; AAOS 97 vs 90, p = 0.026; dorsiflexion restriction 2.8° vs 6.7°, p = 0.003). Outcomes after fibular fractures with an additional posterior fragment were similar to isolated fibular fractures. However, significant differences were found between unimalleolar and trimalleolar (a combination of lateral, medial and posterior) fractures (AOFAS 97 vs 88, p < 0.001; AAOS 97 vs 90, p = 0.003; VAS-pain 1.1 vs 2.3 p < 0.001; dorsiflexion restriction 2.9° vs 6.9°, p < 0.001). There was no significant difference in isolated fibular fractures with or without additional deltoid ligament injury. In addition, no functional differences were found between bimalleolar and trimalleolar fractures. Surprisingly, poor outcomes were found for isolated medial malleolar fractures. Development of osteoarthritis occurred mainly in trimalleolar fractures with a posterior fragment larger than 5 %.

Conclusions: The results of our study show that long-term functional outcome is strongly associated to medial malleolar fractures, isolated or as part of bi- or trimalleolar fractures. More cases of osteoarthritis are found in trimalleolar fractures.

No MeSH data available.


Related in: MedlinePlus