Functional Outcomes After Fracture-Dislocation of the Ankle

Abstract

Background. Fracture dislocation of the ankle represents a substantial injury to the bony and soft tissue structures of the ankle. There has been only limited reporting of functional outcome of ankle fracture-dislocations. This study aimed to compare functional outcome after open reduction internal fixation in ankle fractures with and without dislocation. Methods. A retrospective chart review of surgically treated ankle fractures over a 3- year period was performed. Demographic data, type of fracture, operative time and complications were recorded. Of 118 patients eligible for analysis, 33 (28%) sustained a fracture-dislocation. Mean patient age was 46.6 years; 62 patients, who had follow-up of at least 12 months, were analyzed for functional outcome assessed by the Foot and Ankle Outcome Score (FAOS). The median follow-up time was 37 months. Demographic variables and FAOS were compared between ankle fractures with and without dislocation. Results. The average age of patients sustaining fracture-dislocation was greater (53 vs 44 years, P = .017); a greater percentage were female (72.7% vs 51.8%, P = .039) and diabetic (24.2% vs 7.1%, P = .010). Wound complications were similar between both groups. FAOS was generally poorer in the fracture-dislocation group, although only the pain subscale demonstrated statistical significance (76 vs 92, P = .012). Conclusion. Ankle fracture-dislocation occurred more frequently in patients who were older, female, and diabetic. At a median of just > 3-year follow-up, functional outcomes in fracture-dislocations were generally poorer; the pain subscale of FAOS was worse in a statistically significant fashion. Levels of Evidence: Therapeutic, Level III

Clinical and Radiological Results after Fracture-Dislocations of the Ankle: A Medium- to Long-Term Followup Study

“…Few studies have reported medium- or long-term results in fracture-dislocation of the ankle [ 9 , 11 , 12 , 16 ]. Warner et al [ 9 ] compared short-term functional outcomes in pronation external rotation ankle fractures with and without dislocation.…”

“…All our patients had a fracture-dislocation of the ankle, in some cases caused by low energy trauma, especially in elderly patients. Tantigate et al [ 12 ] reported a retrospective study of 118 patients surgically treated for an ankle fracture; 33 patients (28%) sustained a fracture-dislocation. After a medium followup of 37 months, 62 patients were analyzed for functional outcome assessed by the Foot and Ankle Outcome Score (FAOS).…”

“…In fracture-dislocations of the ankle, major wound complications are reported with a percentage between 3% and 44% [ 10 , 11 , 12 ]. We observed major wound complications only in two patients, but, in the present study, we excluded open fractures.…”

“…In type A, the fracture of the lateral malleolus is under the syndesmosis, in type B, it is trans-syndesmotic, and in type C, it is above the syndesmosis. Type A and B fractures are stable, while type C is unstable and may be fixed with trans-syndesmotic screws [ 8 , 9 , 10 , 11 , 12 ]. Few studies have reported the medium- or long-term outcomes of surgically-treated fracture-dislocations of the ankle [ 11 , 12 ].…”

“…Type A and B fractures are stable, while type C is unstable and may be fixed with trans-syndesmotic screws [ 8 , 9 , 10 , 11 , 12 ]. Few studies have reported the medium- or long-term outcomes of surgically-treated fracture-dislocations of the ankle [ 11 , 12 ]. The aim of our study was to report the long-term results in 26 patients affected by a fracture-dislocation of the ankle surgically treated by open reduction and internal fixation, with a medium followup time of 5.2 years.…”