A FIVE TO SEVEN YEAR OUTCOME ANALYSIS OF INTERNAL FIXATION OF ANKLE FRACTURES

Abstract

We aim to assess the long term functional and symptomatic outcome of patients after open reduction internal fixation (ORIF) of the ankle. A retrospective telephone interview of patients (n=113) in years five, six and seven after ORIF of the ankle was conducted. The Olerud-Molander Ankle Score (scale 0–100) and SF-12 Health Survey scores were utilised to assess symptomatic and functional outcome. Fractures were classified in accordance with the Danis-Weber system. All patients were operated upon in the same unit by the same group of surgeons.

Sixty five patients were male and 48 female. The mean age was 56 (range 15–96). Patients with Weber B fractures (n=83) had a mean OMAS of 89.2. Those with Weber C fractures (n=25) had a mean OMAS of 85.4. Five patients had isolated medial malleolar fractures. At five to seven years post-operatively, 67.3% of patients were symptomatic. Of these, 75% complained of swelling; 39% of pain and 30% of stiffness whilst 19.5% of all patients felt they had not returned to their pre-operative functional level. Regardless of fracture type or follow up time, patients under 40 years old, had a significantly higher mean OMAS (90.7) as compared to those between 40 and 65 years old (85.3) (p=0.024). There was no significant difference in the mean OMAS of patients followed up at five or seven years post operatively or between those with Weber B or C fractures.

Patients suffer ongoing symptomatic and functional problems up to seven years after ORIF of the ankle and a significant number do not return to their pre-injury functional state. Patients under 40 years old had a better outcome as compared to older patients, whilst Weber type or year of follow up did not affect outcome. Surgeons should counsel patients pre-operatively regarding possible long term problems when undertaking ankle fracture fixation.