OUTCOME OF ANKLE FRACTURES AT MINIMUM 3 YEARS POST INJURY

Abstract

Background: Long term follow up data on patients following ankle fracture is scarce. As a follow on from a year long prospective audit of patients admitted to a trauma unit data was collected on a cohort of such patients at a minimum of 4 years post injury to ascertain functional outcome.

Methods: All patients with ankle fractures requiring admission to the Royal Preston Hospital in the period August 2004 to August 2005 were identified. Patients with multiple injuries were excluded. One hundred and one patients were confirmed as fulfilling the criteria that all medical notes were present and the patient had a principle injury of a malleolar fracture. Patients were then invited to a follow up clinic. Functional outcome relating to work and leisure pursuits, the American Orthopaedic Foot and Ankle Society hindfoot score (AOFAS) and a Visual Analogue Scale for residual pain were recorded.

Results: Utilising the Weber classification there were 63% B, 24% C fractures and 5% A fractures. 91 patients underwent surgical fixation. The most common post hospital discharge complication was excessive swelling and 17 patients’ required additional surgery. The only factor that predicted length of follow up before discharge was the presence of diabetes. The Weber classification had no predictive value for length of follow up. 90% of patients returned to their previous work. All ankle fractures had a significant impact on social activities, 45% with a Weber C fracture patients had not returned to their previous sporting activities. The median AOFAS score was 85/100. The median VAS pain score was 9 out of 100. Fifty-eight patients had a change to the type of footwear tolerated.

Conclusion: Patients with an ankle fracture requiring admission to hospital have significant residual symptoms at a minimum four years post injury. Weber B and C fractures have significant long term effects on ADL.