SLR - July 2009 - Ryan Mackey
Reference:
Shah N.H., (2007). Five-year Functional Outcome Analysis of Ankle Fracture Fixation. International Journal of Care of the Injured, 38, 1308-1312.
Scientific Literature Reviews
Reviewed by: Ryan Mackey, DPM
Residency Program: Miami VA Medical Center
Podiatric Relevance:
This study retrospectively examines the functional outcome of patients at 5 years following ankle fracture surgery using the well-established Olerud-Molander Ankle Score (OMAS) and SF-12 questionnaire.
Methods:
A consecutive series of patients who sustained an isolated closed Weber type B or C ankle fracture and underwent fixation between 1999 and 2000 were reviewed. All surgical corrections consisted of ORIF methods with lateral plating for the fibula, syndesmotic screw placement, and 2 lag screws placed within the medial malleolus. Patients who were skeletally immature, patients with multiple injuries, open fractures, pathological or neuropathic fractures were excluded. The patients’ functional outcome was assessed by postal questionnaires. The first was an ankle specific outcome questionnaire devised by Olerud and Molander in 1984, based on a 0 to 100 scale. The second questionnaire was Short Form 12 and its physical and mental health summary measures. The third questionnaire included subjective questions regarding return to work and activity.
Results:
Eighty-five patients were identified as meeting the inclusion criteria and sent postal questionnaires. Sixty-nine patients returned the questionnaire and were included in the study. Forty-three were female, and twenty-six were male. The mean age was 50.7 years. 52 patients had Weber type B fractures , while 17 had Weber type C fractures. After five years, 26 patients reported that they returned to the same activity level, while 16 did not return to pre-injury sporting activity level. 35 patients were still complaining of some pain, while 31 still reported swelling. 44 patients still complained of intermittent stiffness. 27 patients still believed they had not fully recovered. 75% of patients achieved good to excellent functional outcomes using the OMAS scale at 5 years post-surgery. No statistical difference was evident between Weber type B or C, and there was a positive correlation between the OMAS and SF-12 sub-scores. Patients below 40 years old had significantly better outcomes than those older than 40 years, and men had a better functional outcome than women at 5 years.
Conclusion:
The result of this study shows that 5 years after surgical fixation of an unstable ankle fracture, patients will still have some functional and physical residual effect. This fact is important in medico-legal context as well to alert patients what to expect both immediately after surgery and what possibilities exist for long term outcome.