Aims

The primary aim of this study was to present the mid-term follow-up of a multicentre randomized controlled trial (RCT) which compared the functional outcome following routine removal (RR) to the outcome following on-demand removal (ODR) of the syndesmotic screw (SS).

Aims

The aim of this study was to compare the longer-term outcomes of operatively and nonoperatively managed patients treated with a removable brace (fixed-angle removable orthosis) or a plaster cast immobilization for an acute ankle fracture.

Introduction. Ankle fractures represent approximately 10% of the fracture workload and are projected to increase due to ageing population. We present our 5 years outcome review post-surgical management of ankle fractures in a large UK Trauma unit. Methods. A total of 111 consecutive patients treated for an unstable ankle fracture were entered into a database and prospectively followed up. Baseline patient characteristics, complications, further intervention including additional surgery, functional status were recorded during five-year follow-up. Pre-injury and post-fixation functional outcome measures at 2-years were assessed using Olerud-Molander Ankle Scores (OMAS) and Lower Extremity Functional Scales (LEFS). A p value < 0.05 was considered significant. Results. The mean age was 46 with a male:female ratio of 1:1.1. The distribution of comorbidities was BMI >30 (25%), diabetes (5%), alcohol consumption >20U/week (15%) and smoking (26%). Higher BMI was predictive of worse post-op LEFS score (p = 0.02). Between pre-injury and post fixation functional scores at 2 years, there was a mean reduction of 26.8 (OMAS) and 20.5(LEFS). Using very strict radiological criteria, 31 (28%) had less than anatomical reduction of fracture fragments intra-operatively. This was, however, not predictive of patients' functional outcome in this cohort. Within 5-year period, 22 (20%) patients had removal of metalwork from their ankle, with majority 13 (59%) requiring syndesmotic screw removal. Further interventions included: joint injection (3), deltoid reconstruction (1), arthroscopic debridement (1), superficial sinus excision (2), and conversion to hindfoot nail due to failure of fixation (1). Reduction in OMAS was predictive of patients' ongoing symptoms (p=0.01). Conclusion. There is a significant reduction in functional outcome after ankle fracture fixation and patients should be counselled appropriately. Need for removal of metalwork is higher in patients who require syndesmosis stabilisation with screw(s)

Introduction. Open tibial fractures are associated with increased risk of complications, particularly a higher risk of infections and decreased functional outcome. Objectives. To evaluate the incidence of complications and the functional outcomes after managing open tibial fractures with circular fine-wire fixators. Methods. Retrospective review of 35 open tibial fractures treated with circular fine-wire fixators {Ilizarov and Taylor Spatial Frame (TSF)} in a teaching hospital. Patients were reviewed with x rays and clinical outcomes measured using Iowa Knee Score questionnaire, Olerud-Molander Ankle Scores (OMAS), Ankle Evaluation Score and Euroqol EQ-5D descriptive system (generic health questionnaire). Results. Ilizarov frame was used for 19 (56%) and TSF was used for 16 (44%) patients. Mean patient age was 47.1 years. 74% had high energy while 26% had low energy injury. 4 patients (12%) had grade I, 3 (9%) had grade II, 27 (79%) patients had grade III injury as per Gustilo & Anderson Classification. 14% patients had proximal, 17% had mid-shaft, 67% had distal tibial fractures respectively. Average time to union was 28.9 weeks. 12 (35%) had pin-track infection treated with antibiotics. Grade IIIB fractures healed in 29.6 weeks. 17 required soft tissue coverage and only two developed skin graft complications. There was no case of deep infection & mal-union and one patient had non-union. Patients had good satisfaction scores (EQ-5D descriptive system) following surgery (mean = 0.751). The mean Iowa Knee Evaluation score, OMAS and Ankle Evaluation score was 87.32, 73.48 and 74 respectively (maximum being 100). The ankle range of movement was similar in operated and contra lateral normal ankles. Conclusions. We report fewer complications with no incidence of deep infection rates and infection only limited to superficial tissues. Healing time is considerably reduced and there are high satisfaction rates with good functional outcomes