Mid term functional outcomes of reduced and malreduced fractures in two university teaching hospitals

V. Roberts, L. Mason, E. Harrison, A. Molloy, J. Mangwani

Introduction: We performed a longitudinal outcome study involving the operative management of ankle fractures at two university teaching hospitals. This was a retrospective review of the quality of reduction and a prospective study into the functional outcome.

Methods: All patients undergoing open reduction internal fixation of the ankle between November 2006 and November 2007 at one centre, and January to December 2009 at the other were included. Adequacy of reduction was assessed on the initial post-operative radiographs using Pettrone's criterion. The post-operative functional outcome was recorded using the Lower Extremity Functional Scale (LEFS), completed by postal or telephone follow-up at 64 months post injury (60-74 months).

Results: There were 261 patients in the cohort, with a mean age of 47 years (17-91). Weber B fractures were sustained in 193 patients compared to 68 Weber C fractures. The medial malleolus was fractured in 43 cases, and a large posterior malleolar fragment (>20%) was found in 13 cases. Malreduction of the Weber B cohort was identified in 61 ankles (31%): Malreduction of the Weber C cohort was identified in 25 cases (37%): At time of follow-up 26 patients were not traceable or had died. Of the surviving 235 patients, 139 responded to the LEFS questionnaire (60%). The mean LEFS was 58 (out of 80) in the Weber B cohort and 61 in the Weber C cohort. Significantly lower LEFS were found in patients who had a malreduction in 2 or more criteria.

Conclusion: Our study shows that there is high incidence of malreduction in the operative treatment of ankle fractures which leads to a significantly poorer functional outcome. We strongly recommend that adequate care and supervision are used in theatre together with post-operative independent review of intra-operative fluoroscopy images.