Long-term Functional Outcomes After Operatively Treated Unimalleolar, Bimalleolar, and Trimalleolar Ankle Fractures: A 15-22-Year Follow-up Study of 125 Patients.

Abstract

Background: Despite considerable improvements in surgical treatment strategies for unstable ankle fractures, long-term follow-up studies on conventional treatment strategies are missing. The aim of the study was to assess the patient-reported long-term outcome (≥15 years) following surgically treated ankle fractures.

Methods: Retrospective, single-center, outcome study with a current follow-up. Identified were all patients treated surgically for an unstable ankle fracture between January 2003 and October 2009. Treatment was performed according to the AO principles. General demographics, injury-, fracture- and treatment details, as well as the current patient-reported outcome (Olerud-Molander Ankle Score [OMAS], the Foot and Ankle Ability Measure [FAAM], the European Foot & Ankle Society Score [EFAS], and the EuroQoL-5 dimensions, 5 levels [EQ-5D-5L]) were assessed.

Results: Of 398 eligible patients, 125 patients (31.4%; 54% female, 48% left side) were included. The average age at trauma was 43.1 ± 11.8 years, and the mean follow-up 17.8 ± 2.0 years. Overall, 43%, 22%, and 34% sustained a unimalleolar, bimalleolar, and trimalleolar fracture, respectively. In addition, 53% had a fracture to the posterior malleolus. The overall median outcome for the OMAS, FAAM daily, and EFAS daily were 100 (interquartile range [IQR] 15), 99 (IQR 7), and 96 (IQR 16), respectively. The EQ-5D-5L scored at a median of 1.00 (IQR 0.09). The number of malleoli fractured was the only factor affecting all outcome scores. A moderate or poor outcome was reported for 5% of unimalleolar, 18% of bimalleolar, and 30% of trimalleolar fractures.

Conclusion: Although the overall functional outcome was good, about 15% of patients had considerable impairment. The only factor associated with the patient-reported outcomes was the number of malleoli fractured, with 30% of patients with a trimalleolar ankle fracture presenting inferior outcomes.