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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

Flowchart of participants
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Fig3: Flowchart of participants

Mentions: Of the 611 patients with an operatively treated ankle fracture in the study period, 434 met the inclusion criteria and were invited to participate in the study. Of these, 243 agreed to participate and were evaluated between January and May 2012 (Fig. 3). The average age of the participants was 52 years at the time of evaluation after a mean follow-up of 9.6 years (range 5–17 years). One hundred and fourteen participants (47 %) were men; mean Body Mass Index at time of evaluation was 28.0 kg/m2. According to the radiographic classification, the study population consisted of 112 participants with an isolated fibular fractures (group F), 20 participants with a combination of fibular and posterior malleolar fracture (group FP), 9 participants with an isolated medial fracture (group M), 43 participants with bimalleolar fractures (group FM), and 59 participants with trimalleolar fractures (group T). Baseline characteristics of the groups are presented in Table 1. The mean size of the posterior fragment was 16 % (range, 3–53 %). The mean time between trauma and internal fixation (operation delay) was 5 days. Postoperatively, all x-rays showed proper reduction (less than 2 mm dislocation) and a good joint congruency. Fixation of the posterior fragment took place in 11 cases: 8 fragments were larger than 25 % of the involved articular surface, and 3 were between 5–25 %.Fig. 3


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

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

Flowchart of participants
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig3: Flowchart of participants
Mentions: Of the 611 patients with an operatively treated ankle fracture in the study period, 434 met the inclusion criteria and were invited to participate in the study. Of these, 243 agreed to participate and were evaluated between January and May 2012 (Fig. 3). The average age of the participants was 52 years at the time of evaluation after a mean follow-up of 9.6 years (range 5–17 years). One hundred and fourteen participants (47 %) were men; mean Body Mass Index at time of evaluation was 28.0 kg/m2. According to the radiographic classification, the study population consisted of 112 participants with an isolated fibular fractures (group F), 20 participants with a combination of fibular and posterior malleolar fracture (group FP), 9 participants with an isolated medial fracture (group M), 43 participants with bimalleolar fractures (group FM), and 59 participants with trimalleolar fractures (group T). Baseline characteristics of the groups are presented in Table 1. The mean size of the posterior fragment was 16 % (range, 3–53 %). The mean time between trauma and internal fixation (operation delay) was 5 days. Postoperatively, all x-rays showed proper reduction (less than 2 mm dislocation) and a good joint congruency. Fixation of the posterior fragment took place in 11 cases: 8 fragments were larger than 25 % of the involved articular surface, and 3 were between 5–25 %.Fig. 3

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