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Purpose Surgical management of ankle fractures has been extensively studied in literature but studies investigating validated clinical results are lacking and controversial. The purpose of this study was to evaluate functional and health-related quality of life (HRQL) outcomes after surgically treated ankle fractures and to detect some of their predictors. Methods Two hundred sixty-six skeletally mature patients who underwent surgery for an isolated ankle fracture from 2006 to 2017 were retrospectively identified from our hospital records and included in the study. All patients were evaluated at one, three, six and 12 months post-injury with clinical and radiographic examination. Outcome measures recorded at final two years minimum follow-up included patient-reported pain, patient satisfaction, functional (American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score) and quality of life (Short Form (SF) 36 score) status. Results Patient satisfaction score was 8.4 out of 10, Visual Analogue Scale mean score was 2.3, complication rate was 36.5% and mean AOFAS ankle-hindfoot score was 87.3. Mean SF36-physical summary score was 77.9 and SF36-mental summary score was 81.1. The injury demonstrated a significant effect on physical function, role-physical, bodily pain and social functioning SF-36 subdomains. Functional outcome was significantly related to occupation, syndesmotic lesion, number of fractured malleoli and delay to surgery. Main predictors of quality of life were age, occupation, cause of injury, syndesmotic lesion, number of fractured malleoli and waiting time to surgery. Conclusions Ankle fractures have a considerable impact on functional and quality of life status of patients. Occupation, presence of syndesmotic injury, Pott's classification and surgery delay must be considered as predictors of final outcome.
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Injuries to the tibioperoneal syndesmosis are more frequent than previously thought and their treatment is essential for the stability of the ankle mortise.Recognition of these lesions is essential to avoid long-term morbidity.Diagnosis often requires complete history, physical examination, weight-bearing radiographs and MRI.Treatment-oriented classification is mandatory.It is recommended that acute stable injuries are treated conservatively and unstable injuries surgically by syndesmotic screw fixation, suture-button dynamic fixation or direct repair of the anterior inferior tibiofibular ligament.Subacute injuries may require ligamentoplasty and chronic lesions are best treated by syndesmotic fusion.However, knowledge about syndesmotic injuries is still limited as recommendations for surgical treatment are only based on level IV and V evidence. Cite this article: EFORT Open Rev 2017;2:403-409. DOI: 10.1302/2058-5241.2.160084.
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BACKGROUND: Intra-articular tibial plafond fractures are a challenge for the surgeon with generally poor functional outcomes. The purpose was to assess the impact of this injury on patient quality of life (QOL), as well as analyzed the predictor factors. METHODS: Retrospective study of 47 patients with mean age of 44.4 (range 18-79) years. Patients were also invited for new clinical and radiological assessments. QOL was evaluated by the Short Form-36 questionnaire and compared to the standard in the age-matched general population. Olerud-Molander ankle score (OMAS) was used to assess function. Digital radiographs were evaluated for linear and angular measurements. RESULTS: The mean follow-up at last visit was 5.3 (range, 2-10) years. Sequelae were present in 20 patients, mainly including chronic pain (8) and arthrosis (10). Articular step-off at least 2mm was present in 20 patients had, articular gap greater than 2mm in 13, and malalignment in 5. Worse reduction was obtained with external fixation. QOL was significant lower than age-matched general population (p=0.000). Main prognostic factors of worse SF36 were fracture severity, reduction quality and arthrosis. A strong significant relationship was found between SF36-physical and OMAS scores (p=0.000). CONCLUSION: Intra-articular tibial plafond fracture had a dramatic impact on QOL. Among the predictors of unsuccessful outcome, the reduction quality was the only modifiable factor by the surgeon. The OMAS had a predictive value on the prognosis of QOL.
