Clinical and Radiological Results after Fracture-Dislocations of the Ankle: A Medium- to Long-Term Followup Study

Abstract

The authors report the long-term outcome in a series of 26 patients surgically treated for a fracture-dislocation of the ankle by open reduction and internal fixation (ORIF), reviewed after an average followup of 5.2 years. The average age of the patients was 46.8 years; 17 were female and 9 male; the right side was involved in 22 patients and the left side in 4; 10 patients had a unimalleolar fracture, 11 a bimalleolar fracture, and 5 a trimalleolar fracture. The quality of reduction was excellent in 14 cases and good in 12. The functional results were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) score, while radiographic results followed the Van Dijk classification. At followup, the AOFAS score ranged from 75 to 98 points with an average of 87.9, while the radiographic results were evaluated as grade 0 in 16 ankles and grade I in 10. Fracture-dislocations of the ankle occurred more frequently after high-energy traumas in younger patients on the right side, but they were also observed in older females after low-energy trauma. Excellent reduction was correlated with better radiographic results at long term followup. However, these injuries may lead to a poor functional outcome, despite an anatomical reduction and good radiographic results; in fact, in nine of our cases (34.6 percent), the AOFAS score was less than 90 points.

Keywords: ankle; bimalleolar; dislocation; fracture; trimalleolar; unimalleolar.

Figure 1

Radiographic examination of a fracture-dislocation of the right ankle in a 32 year-old man (a,b), reduced in the emergency room and temporarily stabilized by a bivalved cast (c,d).

Figure 2

Radiographic examination with a 3D CT scan reconstruction of a fracture-dislocation of the left ankle in a 45 year-old man (a,b) treated by open reduction and internal fixation. The post-operative X-rays showed an anatomic reduction of the lesion with a stable osteosynthesis (c). At follow up, performed 3.8 years later, after hardware removal, AOFAS was 85 points, in spite of a good range of motion of the ankle and the absence of significant radiographic signs of osteoarthritis (Van Dick grade 0) (d–g).