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J Orthop Trauma. 2016 Jul;30(7):e236-41. doi: 10.1097/BOT.0000000000000571.

Outcomes Over a Decade After Surgery for Unstable Ankle Fracture: Functional Recovery Seen 1 Year Postoperatively Does Not Decay With Time.

Author information

1
*Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, NY; †UAB Department of Orthopaedic Surgery, UAB Orthopaedic Clinic, Birmingham, AL; and ‡Department of Orthopaedic Surgery, Jamaica Hospital Medical Center, Jamaica, NY.

Abstract

OBJECTIVES:

To evaluate long-term clinical and radiographic outcomes after surgical fixation of unstable ankle fractures.

DESIGN:

Prospective follow-up study.

SETTING:

Academic medical center with 2 Level-I trauma centers and a tertiary care center.

PATIENTS:

One hundred forty-one patients who underwent surgical repair of an unstable ankle fracture.

INTERVENTION:

Open reduction internal fixation of an unstable ankle fracture.

MAIN OUTCOME MEASUREMENTS:

Short Musculoskeletal Function Assessment (SMFA) scores and radiographic outcomes based on the van Dijk criteria at a mean of 11.6 years follow-up.

RESULTS:

Of the 281 patients meeting the inclusion criteria for this study, follow-up data were obtained from 141 patients (50%), at a mean of 11.6 years after surgery. Overall, mean long-term SMFA scores were improved when compared with scores at 1 year. The American Society of Anesthesiologists class 1 or 2 was found to be a significant predictor of recovery based on SMFA scores. Sixty-three percent of follow-up radiographs demonstrated evidence of radiographic arthritis, including 31% with mild osteoarthritis, 22% with moderate osteoarthritis, and 10% with severe osteoarthritis. Fracture dislocation at injury was found to be a significant predictor of radiographic posttraumatic osteoarthritis at latest follow-up. One patient (0.7%) underwent a tibiotalar fusion secondary to symptomatic posttraumatic arthrosis. One patient (0.7%) underwent total ankle replacement due to severe osteoarthritis.

CONCLUSIONS:

Our data indicate that over a decade after ankle fracture fixation, most of the patients are doing well. Despite the presence of radiographic arthritis in 63% of patients, few experience pain or have restrictions in function, and mean long-term functional outcome scores are improved when compared with scores at 1 year. Patients undergoing operative fixation of unstable ankle fractures can anticipate functional outcomes that are maintained over time.

LEVEL OF EVIDENCE:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

PMID:
26978134
DOI:
10.1097/BOT.0000000000000571
[Indexed for MEDLINE]

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