Extremities

No decay in subjective function found 10 years after surgery for unstable ankle fracture

TAMPA, Fla. — A long-term follow-up of patients treated with open reduction and internal fixation for unstable ankle fracture showed no decrease in function over time when compared with self-reported results 1 year after fixation.

“The results of our study demonstrate that the majority of patients are doing well over a decade after fracture fixation. Despite the presence of radiographic arthritis in 79% of patients, few experience pain or have restrictions of function,” Deirdre Regan, BA, said at the Orthopaedic Trauma Association Annual Meeting, here.

Regan, a student on the research team at NYU Hospital for Joint Diseases, conducted the study with colleagues Kenneth A. Egol, MD; Kenneth J. Koval, MD; Nirmal C. Tejwani, MD; Stephen Gould, MD, MPH; and Arthur Manoli III, BS.

Deirdre Regan

To determine the long-term outcomes after surgical stabilization of unstable ankle fractures, Regan and colleagues identified 150 patients who were enrolled in a prospective database and followed to 1 year. At the time of surgery, investigators collected patients’ ASA classification, fracture classification, and baseline function using SFMA and AOFAS scores. Patients were seen 3 months, 6 months and 1 year post-fixation, at which time X-rays were obtained, and SFMA and AOFAS scores were assessed. Of these patients, 75 patients responded to requests for clinical and radiographic follow-up. The mean age at follow-up for these patients was 58 years at a mean of 10.5 years post-fixation.

The follow-up cohort was significantly older at the time of injury compared with the original cohort. There were no other significant demographic differences between the groups.

“We found no significant difference between long-term total SMFA scores compared to scores at 1 year. ASA class 1 or 2 was found to be a significant predictor of recovery based on SFMA scores,” Regan said.

Overall, 84% of patients had either no or mild ankle pain and 91% had either no limitations or limitations only in recreational activities. The researchers found 59% of patients had AOFAS ankle-hindfoot scale scores of greater than or equal to 90 and 85% scored greater than 80.

Ten patients underwent hardware removal and one patient underwent tibiotalar fusion secondary to symptomatic post-traumatic arthrosis. Radiographic evidence of osteoarthritis (OA) was present in 79% of patients; 21% had no OA; 50% had mild OA; 25% had moderate OA; and 4% had severe OA. Male gender was a significant predictor of radiographic evidence of OA, Regan said.

“Our findings indicate that in the long term, patients treated surgically for unstable ankle fractures can expect to have similar outcomes to their status at 1 year following fixation,” she said. — by Gina Brockenbrough, MA

Reference:

Gould S. Paper #37. Presented at: Orthopaedic Trauma Association Annual Meeting 2014; Oct. 16-18; Tampa, Fla.

Disclosure: Regan has no relevant financial disclosures. The study was made possible by an Orthopaedic Trauma Association research grant.

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Josh Sandberg

Josh Sandberg is the President of Ortho Sales Partners and Partner for The De Angelis Group. He also serves as Co-Founder and Editor of OrthoSpineNews.

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