FEATURES OF MALLEOLAR FRACTURES PREDICTIVE OF LONG-TERM OSTEOARTHRITIS: A RETRSOSPECTIVE ANALYSIS IF 32 CASES

Abstract

Purpose: We report a series of 32 ankle fractures reviewed 15 years after osteosynthesis.

Material and methods: The series included 12 fibular fractures, 14 bimalleolar fractures, and six trimalleolar fractures. The Weber classification was: type A four, type B 18, type C ten. Postoperative radiograpphy demonstrated 28 anatomic reductions and four shortened fibulae (3 to 5 cm). The results were assessed using the Harper criteria with a Kitaoka radiographic series. The statistical analysis was done with chi square.

Results: At the review 15 years after osteosynthesis, 19 ankles were pain free. Normal mobility was noted in 22 cases, and an absence of oedema in 18. Thirty patients wore normal shoes. Walking was normal in 23 cases; the x-rays revealed tibiotalar narrowing in 12 cases, and lengthenings of the malleolus in 23. Ten cases of tibiotalar narrowings were associated with a long medial malleolus. The objective results were good in 23 cases, fair in eight and poor in one. At fifteen years follow-up, osteoarthritis had developed in 37% of the cases despite anatomic reconstruction in 28. The four fibular shortenings were associated with development of osteoarthritis. Ossification of the medial malleola corresponded to detachment of a non-medial sutured ligament. Ankle osteoarthritis, when present, was particularly well tolerated.

Discussion: The long-term results of osteosyntheis for malleolar fractures was good in this series. Success requires perfect restoration of the joint anatomy. Unlike other series reported in the literature, non-surgical treatment of the medial collateral ligament led to medial periarticular ossifications in the very long term and limited joint mobility. We propose surgical suture of the medial collateral ligament.