Abstract
Between 1993 and 2000 we conducted a prospective study of 50 patients presenting late with ankle fractures. They all had with persistent pain, swelling, ankle deformity and difficulty with walking. Reasons for presenting late included fracture blisters, under-treatment, refusal of surgery and neglect. The mean age of patients was 44.1 years (20 to 82). The mean delay between injury and treatment was 18.4 weeks (4 to 64).
All patients underwent open reduction and internal fixation. Operations were more demanding when done after 24 weeks or in cases of Weber C fractures. Anatomical reduction was achieved in 88% of cases and clinical and radiological deformity corrected in all. All fractures went on to union and patients attained satisfactory motion. There were improvements in pain, swelling and walking. Three cases of deep sepsis were treated with debridement and antibiotics. Ankylosis developed in two patients and arthritis in seven.
The encouraging results suggest that symptomatic, malunited and displaced intra-articular ankle fractures should be treated surgically, even when presented late.
The abstracts were prepared by Professor M. B. E. Sweet. Correspondence should be addressed to him at The Department of Orthopaedic Surgery, Medical School, University of Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193 South Africa
