Long-Term (14 Years) Outcomes of Operatively Treated Ankle Fractures in a Cohort of 330 Patients

Tina Ha, Kirsten Grant, Jane Madeley, Senthil Kumar

Introduction: Although internal fixation surgery of displaced ankle fractures is amongst the most commonly performed operations, there is little published on long-term outcomes. The true incidence of posttraumatic osteoarthritis (PTOA) requiring further intervention is not well known. This study aims to establish the incidence of complications and long-term outcomes, specifically the development of arthritis. Furthermore, it aims to determine the effect of patient characteristics on these outcomes.

Method: All patients who underwent ankle fixation at Glasgow Royal Infirmary between January 2009 and December 2010 were retrospectively identified through our departmental database. Patient demographics, comorbidities and complications including infection, non-union, further surgery, and development of PTOA were recorded. Two proportion hypothesis testing was used to establish whether patient characteristics affected outcomes.

Results: 330 patients underwent ankle fixation surgery during the study period. There was a 1.2% and 1.5% incidence of superficial and deep infection respectively. Revision fixation surgery was necessary in 5/330 patients (1.5%), however 21.5% underwent further surgery including removal of metalwork. The latest clinical information showed 3.6% (12/330) developed PTOA and only 5 required surgeries including 3 ankle fusions. There was a statistically significant increase in the rate of delayed unions (P=0.041) in smokers. There was also a higher rate of deep infection, delayed union and revision surgery in diabetic patients and a higher rate of PTOA and requirement for surgical management of PTOA in overweight patients, although these did not reach statistical significance.

Conclusion: Our results show that internal fixation surgery for ankle fractures is associated with low incidences of both short-term complications and development of arthritis in the long-term. In our study, smokers had higher rates of delayed union but there was no significant correlation between patient characteristics and comorbidities on other outcomes.