Abstract
Introduction: Many authors have stated that open reduction and internal fixation of displaced ankle fractures give better results than conservative management (Hughes et al, Clin Orthop 1979; Tunturi et al, Acta Orthop Scand 1983; Philips et al, JBJS 1985 and ). However, there is little information on the long-term outcome of operated ankle fractures. There is inadequate knowledge of patient perception of ankle function following operative treatment of these injuries.
Aim: To analyse long-term results following operative treatment of these fractures using a patient centred outcome measure.
Methods: 112 patients had undergone operative fixation of isolated, closed bi-malleolar ankle fractures between 1992 and 1996 at Middlesbrough General Hospital. All patients had undergone operative fixation using standard AO principles. An independent assessor ascertained the quality of reduction using standardised radiological parameters (Joy et al JBJS 1974, Sarkisian & Cody J Trauma 1976, Mont et al J Ortop Trauma 1992) to assess the post-operative X-ray films. All postoperative reductions were within the parameters of a good reduction.
The modified Olerud & Molander ankle score questionnaire was sent by post to all patients identified living in the region.
Results: 66 out of 112 patients responded; 34 (52%) leading a sedentary lifestyle and 32 (48%) a moderate/ active lifestyle. Mean age of the patients was 47 years. The follow-up period ranged from 5 to 11 years (average 7 years).
Olerud and Molander scores ranged from 5 to 100, with a mean score of 66.5 (SD 27.6), and median score of 70. Only 9 (13.6%) patients had a score of 100. Comparisons between Olerud and Molander scores were made with regard to: gender, whether metal work was removed at a second operation, Weber classification (B vs C) and patient’s lifestyle. No significant differences were observed
The associations between Olerud and Molander score and the key variables were assessed using non-parametric (Spearman’s) correlation coefficients. None of the variables considered were significantly associated with Olerud and Molander score.
Conclusion: The study would suggest that, despite modern fixation techniques, few patients following bi-malleolar ankle fracture have a symptom free ankle. There is no obvious parameter to predict outcome in patients who are managed appropriately for these injuries.
Theses abstracts were prepared by Professor Roger Lemaire. Correspondence should be addressed to EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
