Background Ankle fractures vary in the amount of displacement, damage to the articular surface and disruption of the ligamentous structures. The consequences of injury will vary according to the fracture pattern and the patient. When a patient sustains an injury we would like to know both the early and late result of treatment for that particular patient. There has been debate about the instrument to be used for this follow up.

The aim of the present study is firstly to determine the outcome after open reduction and internal fixation of ankle fractures using the AO/ASIF principles and secondly to determine if the modified version of the scoring system of Phillips et al was appropriate for early and late follow up.

Method Retrospective analysis of case notes and radiographs of patients requiring ORIF of an Ankle fracture between 01/01/98 to 30/03/00. The end date was chosen so that all patients had a minimum of one year followup.

Patients with incomplete follow up, notes and radiographs were excluded. Functional outcome was assessed using a modified version of the scoring system of Phillips et. al. This was sent to patients by post.

Results 106 patients were included in the study. 50 male and 56 female. Age ranged from 14 to 83 mean 47. There were 6 type A, 43 typeB and 59 type C fractures according to the Danis Weber system.

2 were open fractures. There were 5 patients with significant associated injuries. 29 patients had significant co-morbid conditions.

29 patients had surgery on the date of admission. The mean interval to surgery was 3 days.

Patients were followed up regularly in the Out patients clinic

Reduction of fracture was assessed on post operative radiographs using the criteria of Joy et al (1974).

66 patients returned the questionnaire and the functional outcome was determined for this group. 51 patients had an excellent result, 6 patients had a good result, 5 patients had a satisfactory result 4 patients had a poor result. Detailed outcome and complications will be presented in our paper.

Conclusions Fixation of Ankle fractures according to the AO/ASIF guidelines gives good results in the short term with acceptable rate of complications.

Subjective assessment is satisfactory for measuring early and late outcome after Ankle surgery.

No statistically significant factors affected outcome in our study.

Injury to the dorsomedial cutaneous nerve has been identified as a potentially frequent occurrence after hallux valgus surgery. The existence of pre-operative pressure neuropathy is also described but remains largely unexplored. This study was performed to investigate the incidence of pre-operative sensory deficit in the hallux valgus toe, and to examine to what extent any deficit was related to the degree of joint angulation.

A cohort of 43 patients (61 hallux toes) presenting for consideration of surgical correction had their sensation tested in pre-designated sensory zones using a five-filament set of Semmes-Weinstein monofilaments. These allowed good inter-observer reliability with an ICC (intra-class correlation coefficient) of 0.84 overall.

Whilst sensory symptoms were self reported in only 21% of the feet, a measurable reduction in sensation by one monofilament grade or more was found in an additional 44% of the feet. No relationship was found between the degree of sensory loss and degree of angulation.

Patients with symptomatic hallux valgus may have sensory loss of the toe despite not being aware of the deficit. Normal subjective sensation does not reliably predict normal sensory function. Given the potentially high rates of intra-operative nerve damage in hallux surgery we recommend objective sensory testing as part of routine pre-operative assessment.