Is surgery the only option for unstable ankle fracture?
Keywords:Ankle fracture, Unstable ankle, Bimalleolar and trimalleolar fracture
Background: Ankle fracture is one of the most common injuries in sports and daily activity. Unstable ankle fracture that are displaced fracture of the lateral malleolus and most bimalleolar or trimalleolar fractures need surgical reduction and fixation.
Methods: It is a single centre study in which all unstable ankle fracture above the age of 18 and not associated with any other injury were included in the study. Following fixation patients were followed up at 6 weeks, 3 months and 6 months and functional outcome was assessed with American Orthopaedic Foot and Ankle score (AOFAS).
Results: Supination external rotation injury was most common type. Mean AOFAS score at the end of six months was found to be best in supination adduction type. Posterior malleolus fixation with screw were found to have maximum AOFAS score.
Conclusions: Surgical outcome in unstable ankle fracture are proved to have good functional outcome.
Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int. 1994;15:349-53.
Obremskey WT, Dirschl DR, Crowther JD, Craig WL 3rd, Driver RE, LeCroy CM. Change over time of SF-36 functional outcomes for operatively treated unstable ankle fractures. J Orthop Trauma. 2002;16:30-5.
Lash N, Horne G, Fielden J, Devane P. Ankle fractures: functional and lifestyle outcomes at 2 years. ANZ J Surg. 2002;72:724-30.
Day GA, Swanson CE, Hulcombe BG. Operative treatment of ankle fractures: a minimum ten-year follow-up. Foot Ankle Int. 2001;22:102-6.
Lawson KA, Ayala AE, Morin ML, Latt D, Wild JR. Ankle Fracture- Dislocations: A review, American Orthopaedic Foot & Ankle Society, 2018.
Egol KA, Tejwani NC, Walsh MG, Capla EL, Koval KJ. Predictors of Short-Term Functional Outcome Following Ankle Fracture Surgery. J Bone Joint Surg Am. 2006;88(5):974-9.
Jordan TH, Talarico RH, Schuberth JM. The Radiographic fate of the syndesmosis after trans-syndesmotic screw removal in displaced ankle fractures, 2011. J Foot Ankle Surg. 2011;50(4):407-12.
Koval KJ, Lurie J, Zhou W, Sparks MB, Cantu RV, Sporer SM, et al. Ankle fractures in the elderly: What you get depends on where you live and who you see. J Orthop Trauma. 2005;19:635-9.
Jaskulka RA, Ittner G, Schedl R. Fractures of the posterior tibial margin: Their role in the prognosis of malleolar fractures. J Trauma. 1989;29:1565-70.
De Vries JS, Wijgman AJ, Sierevelt IN, Schaap GR. Long-Term results of ankle fractures with a posterior malleolar fragment. J Foot Ankle Surg. 2005;44(3):211-7.
Lindsjö U. Operative treatment of ankle fracture-dislocations. A followup study of 306/321 consecutive cases. Clin Orthop Relat Res. 1985;199:28-38.
McDaniel WJ, Wilson FC. Trimalleolar fractures of the ankle. An end result study. Clin Orthop Relat Res 1977;122:37-45
Macko VW, Matthews LS, Zwirkoski P, Goldstein SA. The joint-contact area of the ankle. The contribution of the posterior malleolus. J Bone Joint Surg Am. 1991;73:347-51.
Broos PL, Bisschop AP. Operative treatment of ankle fractures in adults: Correlation between types of fracture and final results. Injury. 1991;22:403-6.
Brown TD, Hurlbut PT, Hale JE, Gibbons TA, Caldwell NJ, Marsh JL, et al. Effects of imposed hindfoot constraint on ankle contact mechanics for displaced lateral malleolar fractures. J Orthop Trauma. 1994;8:511-9.
Hartford JM, Gorczyca JT, McNamara JL, Mayor MB. Tibiotalar contact area. Contribution of posterior malleolus and deltoid ligament. Clin Orthop Relat Res. 1995;320:182-7.
De Souza LJ, Gustilo RB, Meyer TJ. Results of operative treatment of displaced external rotation-abduction fractures of the ankle. J Bone Joint Surg Am. 1985;67:1066-74.
Talbot M, Steenblock TR, Cole PA. Posterolateral approach for open reduction and internal fixation of trimalleolar ankle fractures. Can J Surg. 2005;48:487-90.
Chung Hyun Wook, Kim Dong Hwan, Si Hoon Yoo, and Jin Soo Suh, Treatment of the Posterior Malleolar Fracture Using Posterior Approach. J Korean Fracture Society. 2010;50-56.
Lee JY, Ha SH, Noh KH, Lee SJ. Treatment of the Posterior Malleolar Fragment of Trimalleolar Fracture Using Posterolateral Approach: Preliminary Report. J Korean Orthop Assoc. 2009;44(4):422-8.
Miller A, Carroll E, Parker R, Helfet D, Lorich D. Posterior Malleolar Stabilization of Syndesmotic Injuries is Equivalent to Screw Fixation. Clin Orthop Related Res. 2010;468(4):1129-35.
Solan MC, Sakellariou A. Posterior Malleolus fractures worth fixing, Bone Joint J. 2017;99:1413-9.
Lampridis V, Gougoulias N, Sakellariou A. Stability in ankle fractures: diagnosis and treatment, Effort open reviews. 2018.
Tosun B, Selek O, Gok U, Ceylan H. Posterior malleolus fractures in trimalleolar ankle fractures: Malleolus versus transyndesmal fixation. Indian J Orthop. 2018;52:309-14.
Drijfhout van Hooff CC, Verhage SM, Hoogendoorn JM, Fragment size and Postoperative Joint Congruency on Long-Term Outcome of posterior Malleolar Fractures. Foot Ankle Int. 2015;36(6):673-8.