Outcomes Over a Decade After Surgery for Unstable Ankle Fracture: Functional Recovery Seen 1 Year Postoperatively Does Not Decay With Time.

Abstract

To evaluate long-term clinical and radiographic outcomes after surgical fixation of unstable ankle fractures. Prospective follow-up study. Academic medical center with 2 Level-I trauma centers and a tertiary care center. One hundred forty-one patients who underwent surgical repair of an unstable ankle fracture. Open reduction internal fixation of an unstable ankle fracture. Short Musculoskeletal Function Assessment (SMFA) scores and radiographic outcomes based on the van Dijk criteria at a mean of 11.6 years follow-up. Of the 281 patients meeting the inclusion criteria for this study, follow-up data were obtained from 141 patients (50%), at a mean of 11.6 years after surgery. Overall, mean long-term SMFA scores were improved when compared with scores at 1 year. The American Society of Anesthesiologists class 1 or 2 was found to be a significant predictor of recovery based on SMFA scores. Sixty-three percent of follow-up radiographs demonstrated evidence of radiographic arthritis, including 31% with mild osteoarthritis, 22% with moderate osteoarthritis, and 10% with severe osteoarthritis. Fracture dislocation at injury was found to be a significant predictor of radiographic posttraumatic osteoarthritis at latest follow-up. One patient (0.7%) underwent a tibiotalar fusion secondary to symptomatic posttraumatic arthrosis. One patient (0.7%) underwent total ankle replacement due to severe osteoarthritis. Our data indicate that over a decade after ankle fracture fixation, most of the patients are doing well. Despite the presence of radiographic arthritis in 63% of patients, few experience pain or have restrictions in function, and mean long-term functional outcome scores are improved when compared with scores at 1 year. Patients undergoing operative fixation of unstable ankle fractures can anticipate functional outcomes that are maintained over time. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.