Mismanaged Ankle Fractures, is it too Late to Save the Joint?

CATEGORY: Trauma; Ankle INTRODUCTION/PURPOSE: Mimanaged ankle fractures with a short fibula, talat shift, syndesmotic widening, malunion or nonunion following inappropriate conservative treatment or inadequate operative treatment are very challenging, especially in young patients. Whether or not to revise the fracture fixation after a period of time with weight bearing with a malaligned joint is a difficult question regarding the value of the operation after that time to prevent arthritis.The aim of the study was to evaluate the effect of operative intervention in these cases in improving symptoms and preventing arthritis METHODS: The study was a prospective study. Inclusion criteria were mismanaged ankle fractures with a reasonable range of motion. Exclusion criteria were infection, severe arthritis, complete loss of motion, ischemia and diabetes. Standing radiographs for both limbs and CT scans were obtained for all patients to analyze the problem. Operative treatment was planned accordingly, and regular follow up was performed clinically and radiologically. RESULTS: 29 patients were included. The average duration from the primary injury or primary fixation was 6 months (range 1.5 to 28 months). The lateral malleolus with or without the syndesmosis were affected in 25 out of 29 cases, the posterior malleolus was affected in 2 cases, the medical malleolus in 6 cases and the deltoid ligament in 12 cases. The minimum follow up duration was 9 months with a range from 9 months to 6 years. Three patients required an ankle fusion later. Ten patients report excellent results, 10 patients report good results, 4 patients report fair results and five patients report bad results, three of them underwent ankle arthrodesis.AOFAS score improved significantly from a mean of 28 points preoperative to a mean 85 points postoperative. CONCLUSION: Perfect primary treatment for ankle fractures is the best method for a good prognosis, but it is not late to reconstruct the joint if there is a reasonable range of motion.This can give good results and delay fusion, and it can make arthroplasty a valid option by restoring ankle anatomy and stability.