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Foot Ankle Int. 2013 Jun;34(6):805-10. doi: 10.1177/1071100712472490. Epub 2013 Feb 20.

Functional outcome and limitation of sporting activities after bimalleolar and trimalleolar ankle fractures.

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  • 1University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Hospital, Singapore 119228, Singapore.



Ankle fractures are extremely common. However, the outcomes of operatively treated bimalleolar and trimalleolar ankle fractures remain unclear. We aimed to evaluate and compare the functional outcomes of operatively treated bimalleolar versus trimalleolar ankle fractures and the ability of patients to return to sporting activities.


A retrospective review of all patients with operatively treated ankle fractures for a period of 2 years was performed. Demographics, fracture pattern, operative details, postoperative radiographs, and complications were extracted and analyzed statistically. Outcome variables were union rates, pain ratings using the visual analogue scale (VAS) and the Olerud and Molander (O&M) score, ability to return to sporting activities, satisfaction with surgery, and surgical complications.


Forty-seven patients with bimalleolar and trimalleolar ankle fractures were recruited. At 1 year postoperatively, most patients regained good function and had good to excellent O&M scores. There were no notable differences in terms of VAS and O&M scores for both the bimalleolar and trimalleolar group. However, 26 (55.3%) of 47 patients had residual pain. Twenty-nine (61.7%) patients complained of stiffness, and 21 (44.7%) patients had ankle swelling. Of 33 (70.2%) patients who were involved in sporting activities prior to the ankle injury, 9 of 33 (27.3%) were able to return to preinjury level of sporting activities with no difficulties. Of the 33 patients, 18.2% were unable to do sports activities at all.


The majority of our patients recovered well in their second year despite some residual deficits. We found no difference in functional outcome between bimalleolar and trimalleolar ankle fractures, although it is of great concern that a notable number of patients will not return to sporting activities. Residual symptoms and functional limitation after ankle fracture must be emphasized to patients to manage postoperative expectations.


Level II, retrospective case series.


bimalleolar ankle fracture; functional outcome; return to sporting activities; trimalleolar ankle fracture

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