Sat., 10/18/08 Foot & Ankle/Pediatrics, Paper #61, 11:44 am OTA-2008
Effect of Posterior Malleolus Fracture on Outcome after Unstable Ankle Fracture
Nirmal C. Tejwani, MD (a,b-Biomet; b-Stryker, Zimmer); Brian Pahk, BS (n);
Kenneth A. Egol, MD (a-Smith + Nephew, Stryker, Synthes; a,b-Biomet; b-Exactech, Inc; d-Johnson & Johnson);
Department of Orthopaedics, New York University Hospital for Joint Diseases, New York, New York, USA
Introduction: Unstable ankle fractures require surgical treatment; however, they present a wide spectrum of injuries with different outcomes. The purpose of this paper is to compare clinical and functional outcomes of surgically treated fractures with posterior malleolus fracture as compared to bimalleolar and unimalleolar ankle fractures without posterior malleolus fracture.
Methods: A prospective database was established to enroll all unstable ankle fractures treated operatively at our institution from October 2000 to July 2005. Demographic data on 456 patients who sustained an unstable fracture of the ankle and were treated surgically were entered into a database and the patients were prospectively followed. Of the 295 patients who had at least 1year follow-up and had complete data available, 65 patients sustained a trimalleolar (posterior malleolus) fracture. The other 230 patients had a uni- or bimalleolar (no posterior malleolus) fracture. Of the 65 trimalleolar fractures, 20 underwent fixation of the posterior malleolus. All patients followed a similar postoperative protocol. They were followed at 3, 6, and 12 months after surgery and assessed functionally with Short Musculoskeletal Functional Assessment (SMFA) and American Orthopaedic Foot and Ankle Society (AOFAS) scores.
Results: There was no difference in age, sex distribution, or American Society of Anesthesiologists classification or incidence of diabetes between the two groups. At 1-year follow-up, all patients improved their function and pain status over the 12 months. Using the AOFAS scores, 20% of patients with trimalleolar fracture still had pain as compared to 15% in the other group (P = 0.52, not significant); the difference in function was also not significant. Using the SMFA, there was no significant difference at 1 year either for the Bother index (P = 0.88) or the Dysfunction index (P = 0.86).
Conclusions: Most patients treated surgically after unstable ankle fractures do well; however, some patients continue to have some pain and dysfunction at 1 year. The outcomes are not significantly different between patients with unstable ankle fractures associated with posterior malleolus fractures and those with uni- or bimalleolar fractures without posterior fracture, contrary to previously published reports. The presence of a posterior malleolus fracture may indicate higher energy of injury, but does not seem to result in worse outcomes at 1 year.
Clinical Significance: It is important to counsel patients regarding the outcomes following ankle fractures treated surgically and to temper their expectations regarding function and pain.
If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.