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.

The aim of the study was to find out the relationship between delay in fixation of ankle fractures and incidence of wound complications like wound dehiscence, necrosis of margins, infection. Ankle fractures are fixed either on the day of injury or delayed for up to 7 days in view of the swelling. We reviewed 51 patients with ankle fractures retrospectively (exclusions- children, open fractures, co-morbid conditions like diabetes, steroid use) looking for delay in surgical fixation and wound complications. Out of 19 patients operated within 24 hours of injury, only one had a wound complication. This was 8 out of 20 for patients operated anywhere between 24 hours and 7 days. 12 patients had their fractures fixed after 7days, out of which 4 developed wound problems. (p value- < 0.05). This suggests that delay in ankle fracture fixation increases the rate of wound related problems. Review of case notes suggested that most patients in the second group (24 hours to 7 days) were waiting for the available slot in the trauma list. Based on these observations we suggest that ankle fractures should be prioritized in trauma lists and fixed within 24 hours of injury.

The purpose of this study was to find out whether routine post operative check radiographs after DHS (Dynamic Hip Screw) fixations are contributing to patient management. In a random selection of 50 NHS hospitals in England, 18 orthopaedic units were found to be ordering formal check radiographs after DHS. In our department check radiographs were routinely being done even though image pictures were printed in theatre. We reviewed 174 DHS fixations, assessed adequacy of image intensifier pictures and compared them with post operative radiographs. 115 stable fractures showed no change in position of fracture or screw. In 59 unstable fractures 14 showed medialisation of femoral shaft. 132 case notes were reviewed and none of these patients have had a change in post operative mobilization status based on check radiographs. The 14 unstable fractures which showed change in position too continued with mobilization.

We conclude that routine check radiographs are unnecessary after DHS fixations if adequate image pictures are obtained at surgery. It has important implications like manpower and cost, patient discomfort and unnecessary radiation.

Aim: To identify the variables associated with poor radiological outcome in the distal radius fractures stabilized with K wires.

Materials & Methods: All the patients who underwent K wire fixation of distal radius fracture in last 3 years were included in this retrospective study. AO Classification was used to classify the fracture. Immediate post fixation radiographs and radiographs taken just prior to removal of K wires (5–6 weeks) were analyzed to study three radiological parameters (dorsal tilt, radial tilt, ulnar variance). Changes in these parameters were recorded. Results were graded as excellent, good, fair and poor according to the Stewart classification. The results were analyzed against variables like age, sex, AO classification, associated ulnar fracture, number of k wires used, delay in fixation and duration of fixation. Statistical tests were performed to find out variables associated with the poor radiological outcome.

Results: 113 distal radius fractures were analyzed in total. Average age of patients was 56.2 years (standard deviation-19.9) with male to female ratio of 1:2.1. Average loss of radial tilt was 4.12 deg, loss of dorsal tilt was 8.07 deg and change in the ulnar variance was 3.12 mm. We found excellent results in 23.9 %, good result in 56.6%, fair results in 15 % and poor results in 4.4 % of patients.

Age more than 65 years (p value 0.006), comminuted distal radius fracture [A3 or C3 in AO classification] (p value 0.049) and associated ulnar fracture (p value 0.013) were the variables found to have statistically significant correlation with poor radiological outcome.

Conclusion: Age more than 65, comminuted distal radius fracture and associated ulnar fracture are the variables associated with poor stability of K wire fixation in distal radius fracture. Alternative mode of stabilization should be considered to improve the stability of the fracture fixation in these patients.