Functional Outcomes After Fracture-dislocation Of The Ankle

Transcription

1 Functional Outcomes After Fracture-dislocation Of The Ankle Direk Tantigate, MD, Gavin Ho, BA, Joshua Kirschenbaum, Christina E Freibott, BA, Benjamin Ascherman, BA, Justin K Greisberg, MD, J. Turner Vosseller, MD. Department of Orthopaedic Surgery, Columbia University Medical Center, NY, USA

2 No Conflicts to Disclose Direk Tantigate, MD, Gavin Ho, BA, Joshua Kirschenbaum, Christina E Freibott, BA, Benjamin Ascherman, BA, Justin K Greisberg, MD, J. Turner Vosseller, MD Our disclosures are in the final AOFAS app. We have no potential conflicts with this presentation. 2

3 Background Fracture-dislocation of the ankle is relative uncommon but represents a substantial injury to the bony and soft tissue structures of the ankle Although there is a wealth of reported outcome after operative treatment of ankle fractures, there has been a limited focus on functional outcome of surgically treated ankle fracture-dislocations The purpose of this study is to compare short-term functional outcome after open reduction and internal fixation (ORIF) in ankle fractures with and without dislocation 3

4 Material and Methods A retrospective chart review of 121 patients older than 18 years who underwent ORIF of ankle fractures from 2010 to 2013 was performed Three patients were excluded; 2 open injury and 1 delayed union 62 patients, who had a duration of follow-up 12 months, were eligible for analysis of the functional outcome Functional outcome was assessed by Foot and Ankle Outcome Score (FAOS) at the last follow up visit 4

5 Material and Methods The mean age was 48.5 ± years (range, 19-85) 61.3% (38 patients) were female 18 patients (29%) had a fracture-dislocation of the ankle The median follow up was 37 months (range, 12-76) 5

6 Comparison of Demographics and Wound complication Variables Nondislocation Fracture-dislocation P value (44 patients) (18 patients) Age (years, mean ± SD) 47 ± ± Gender: Female (n,%) 26, 59.1% 12, 66.7%.578 Side (Left) (n,%) 24, 54.5% 9, 50%.745 ASA score (n,%) - ASA 1 - ASA 2 - ASA 3 10, 22.7% 28, 63.6% 6, 13.6% 4, 22.2% 14, 77.8% BMI (median, IQR) 26.93, , Diabetes (n,%) 1, 2.3% 3, 16.7%.036 Current tobacco usage (n,%) 5, 11.4% 1, 5.6% Type of fracture (n,%) - Distal fibular - Bimalleolar equivalent - Bimalleolar - Trimalleolar 11, 25% 8, 18.2% 19, 43.2% 6, 13.6% 1, 5.6% 2, 11.1% 6, 33.3% 9, 50%.017 6

7 Comparison of Demographics and Wound complication Variables Weber classification (n,%) - Type B - Type C Nondislocation (44 patients) 38, 81.8% 8, 18.2% Fracture-dislocation (18 patients) 12, 66.7% 6, 33.3% P value Syndesmosis injury (n,%) 6, 13.6% 4, 22.2%.404 Time from injury to surgery (days, 9, , median, IQR) Type of fibular fixation (n,%) - Posterior plating 38, 86.4% 16, 88.9% Lateral plating 3, 6.8% 2, 11.1% - Dual plating 2, 4.5% 1, 2.3% - intramedullary screw Operative time (min, median, IQR) 100, , Length of stay (days, median, IQR) 0, 0-2 3,

8 Comparison of Demographics and Wound complication Variables Nondislocation (44 patients) Fracture-dislocation (18 patients) P value Subsequent complication (n, %) Wound complication 3, 6.8% 1, 5.6% - Deep venous Thrombosis 1, 2.3% 0 - Neurapraxia - Surgical site infection 1, 2.3% 0 1, 5.6% Wound complication (n, %) Wound erythema 2, 4.5% - Wound dehiscence 1, 2.3% 1, 5.6% - Surgical site infection 1, 5.6% Subsequent hardware removal (n,%) 6, 13.6% 5, 27.8%.105 8

9 Comparison of FAOS between Surgery < 14 and 14 Days Variables Nondislocation (44 patients) Fracture-dislocation (18 patients) P value FAOS score (median, IQR) - Symptoms 85.71, , Pain 91.67, , Activities of daily living 95.59, , Sports 85, , Quality of life 62.5, ,

10 Discussion Fracture-dislocations of the ankle presented with more trimalleolar fractures and required significant longer operative time and postoperative stay. After one year follow up, patient sustained fracture-dislocation had a significant inferior outcome on pain subscale of FAOS. Although the results showed no statistical difference in the other subscales, there was a trend towards worse outcomes in the dislocation cohort that a larger study may be able to discern. 10

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