Prospective Patient Reported Outcomes (PRO) Study Assessing Outcomes of Surgically Managed Ankle Fractures

Abstract

Background: Ankle fractures are a common cause of morbidity that have increased in incidence over the past decade. The purpose of this study was to compare the outcomes and prognosis of various fracture subtypes by using 2 validated patient-reported outcome measures: the Patient-Reported Outcome Measurement Information System (PROMIS) Physical Function (PF) and Pain Interference (PI) Computer Adaptive Tests (CATs). Methods: Twelve-month postoperative PF and PI CATs were collected for 126 ankle fracture patients presenting between 2014 and 2017. Patients were stratified by ankle fracture subtype and refined by the presence/absence of concomitant deltoid injury or posterior malleolar fracture. Patients defined as members of vulnerable populations and patients presenting more than 2 weeks from time of injury or with prior acute ipsilateral fracture were excluded. The distribution of PF and PI T scores were assessed via a Shapiro-Wilk test and a 1-way analysis of variance. If significant differences were found between groups, pairwise comparisons were tested via Dwass, Steel, and Critchlow-Fligner multiple comparison analysis. Results: Mean values for the PROMIS PF and PI for each fracture subtype were calculated and compared to reference population mean (SD) T scores of 50 (10): isolated lateral malleolar (PF: 50/PI: 51), isolated medial malleolar (PF: 52/PI: 49), bimalleolar (PF: 48/PI: 50), trimalleoar (PF: 47/PI: 51), isolated posterior malleolar (PF: 53/PI: 44), and isolated syndesmotic injury (PF: 60/PI: 46). Shapiro-Wilk test indicated a nonnormal distribution for the postoperative PROMIS PF T scores across all fracture patients ( P = .0421). Conclusion: Operative fixation of an ankle fracture was able to return most patients to the population mean with regard to PROMIS function and pain regardless of fracture type. Level of Evidence: Level II, prospective comparative study.

Risk Factors Associated With Worse Clinical Outcomes of Ankle Fractures Involving the Posterior Malleolus

“…Gilley et al also found a nonnormal distribution of postoperative PROMIS Physical Function scores across fracture subtypes, with worse PROMIS Physical Function scores in patients with bimalleolar and trimalleolar involvement, when compared to isolated medial, lateral, and posterior malleolar fractures. 11 Our results support that trimalleolar fractures are associated with worse patient-reported outcomes as measured by PROMIS. However, it is important to consider that our sample size of 19 patients in the bimalleolar ankle fracture group is small compared to our larger sample size of trimalleolar fractures, which may decrease the strength of this finding.…”

Clinical Improvement Following Operative Management of Ankle Fractures Among Patients With and Without Moderate to High Depressive Symptoms: An Analysis Using PROMIS

“…However, we believe that the general recovery pattern is likely similar, which is supported in the literature as well. 9 Further, all ankle fractures in our study were operatively managed. Additionally, previous studies have also evaluated clinical outcomes across multiple different ankle fracture types as a single patient sample.…”

Syndesmotic Injury in Tibial Plafond Fractures Is Associated With Worse Patient Outcomes

“…Dean et al 19 reported a mean PROMIS PF T score of 51.9 and PI T score of 47.8 in 142 patients with ankle fracture at a mean of 6 years of follow-up. Gilley et al 20 reported a mean PF T score of 48 in 44 patients with trimalleolar ankle fracture. The mean PF T score of 46 and PI T score of 51 in this study is reasonable given previous reported results in patients with ankle fractures.…”