Abstract
Introduction: Operative fixation is the mainstay of treatment for displaced ankle fractures. Results however can be variable, with patients complaining of residual pain and stiffness of the ankle joint. In addition, metalwork can be problematic giving rise to symptoms in up to 25% of patients. We undertook a retrospective study to evaluate outcome in terms of functional and radiological criteria in a cohort of patients.
Aim: To assess outcome in a cohort of patients following operative treatment of ankle fractures.
Materials and Methods: Patients with suitable injuries sustained were identified from the hospital HIPE database. Data was collated from hospital records including demographic details, mechanism of injury, details of the initial injury and surgical treatment. Patients were invited to attend for clinical and radiological examination of the injured ankle. Patients completed the SF12, the Olerud ankle score and a visual analogue pain scale (VAS) on arrival at the clinic. The range of motion of both the injured and uninjured ankle were examined. Finally, the patient’s injured ankle was evaluated on plain X-rays using Cedell’s scoring system. Comparison was made with initial roentgens at the time of injury.
Results: From 106 patients treated over a four-year period, 63 were successfully followed up. Mean time of follow up was 3.5 years. Older patients had a poorer recovery, as had those with more severely displaced fractures. Pain was not a major problem for patients with 58 complaining of no pain, or pain only after prolonged exercise. 43% of patients complained of occasional swelling of the affected limb. The majority of patients (89%) had returned to their previous occupations at the time of follow up. 16% of patients (10) had their metalwork removed post operatively. In seven cases, this was due to skin problems or pain adjacent to the metalwork.
Conclusion: Older age at presentation, and severity of initial injury appear to have a significant effect on long-term outcome, which may be attributable to poorer osteosynthetic ability in an elderly osteoporotic patient. Our study underlines the importance of accurate anatomical reduction of ankle fractures in order to minimise subsequent arthrosis.
The abstracts were prepared by Mr Ray Moran. Correspondence should be addressed to him at Irish Orthopaedic Associaton, Secretariat, c/o Cappagh National Orthopaedic Hospital, Finglas, Dublin 11.
