Functional outcomes of surgical treatment of ankle fractures clinical and radiological evaluation and comparison with sturdy ankle

AIM The ankle joint is an important part of walking function of the body. Surgical treatment is necessary in case of displaced and unstable fractures and also joint complience can not be provided by conservative procedures. The main aim of the surgical treatment is to maintain the anatomical position of the talus bone in ankle to ensure a normal tibiotalar coalition. The most important factors that affects the outcome of the treatment for ankle fractures are the types of fracture, numbers of fractured malleolar bones, qualification of reduction, and the age of patient. In the study of this case; the clinical, functional and radiological results are evaluated based on the compariments between an healthy ankle and the outcomes of a surgical treatment for an ankle fracture on an adult patient. MATERIALS AND METHODS The outcomes of 73 patients that applied to Duzce University Faculty of Medicine both Orthopedy- Traumatology Department and Emergency Department between January 2006 and October 2015, who was diagnosed with ankle fractures and underwent a surgical treatment based on that diagnose, have been evaluated retrospectively for clinical, functional and radiological terms and have been compared with healthy ankle conditions. During this evaluation, Danis-Weber and Lauge-Hansen ankle fracture classifications are used. And the functional results are evaluated by using AOFAS(hindfoot) score, Weber score (compariment with collateral ankle) and FREIBURG score. RESULTS This group of 73 patients who enrolled in this study and were performed surgical treatment includes 40 males (%54.8) and 33 females (%45.2) . In the age group of 14-44; there is 19 males (%47.5) and 19 females (%57.58). And there is 21 males (%52.5) and 14 females (%42.42) in age group of 45-70. 35 of these patients had fracture on their right ankles (%47.95) , and 38 of them had fracture on their left ankles (%52.05). Overall of these patients who were performed surgical treatment, 34 patients had bimalleolar fracture (%46.58) , 8 patients had trimalleolar fracture (%10.96) , 14 patients had lateral malleolar fracture (%19.18) , 13 patients had medial malleolar fracture (%17.81), 1 patient had posterior malleolar fracture and ankle dislocation (%1.37) and 1 patient had both medial and posterior malleolar fractures (%1.37). It was formed as 29 of these fractures were caused by simple falls (%39.73) , 10 of them were caused by NVTA (non-vehicle traffic accident) (%13.70) , 16 of them were caused by sprains (%21.92) , 6 of them were caused by sport injuries (%8.22) , 5 of them were caused by having reduction over the leg (%6.85) , 4 of them were caused by motorcycle accident (%5.48) , 1 of them was caused by gun shot injury (%1.37), 1 of them was caused by tractor accident (%1.37) , and 1 of them was caused by animal repercussion (%1.37). Statistically the etiology of simple falls in the age group of 18-35 was found to be significantly lower than in the age group of 56-70. (p=0.07) According to Lauge Hansen classification , the most common type of the fractures was detected as SER(supination external rotation) ankle fracture (14 cases) (%19.18) , followed by PER (pronation external rotation) ankle fracture (14 cases) (%19.18). There were also detected 10 cases of SAD(supination adduction) (%13.70) and 7 cases of PAB ( pronation abduction) (%9.59). According to Danis Weber classification , the most common type of the fractures was found as Type C (21 cases) (%52.50) , followed by Type B (14 cases) (%35.00) . Statistically there was found no significant difference between the fracture union times considered all of the fracture types. (p=0.064) It is observed that the rates of poor outcomes increased depending on longer preoperative duration than usual, although statictically it was not significant according to all 3 scoring system. According to Weber classification , statistically the great healing and improvement rate in the age group of 18-35 are found significantly high. (p=0.029) And great outcomes in lateral malleolar fractures treatment are found significantly high according to Weber's protocol. The patients AOFAS score was found as 92.11, who was diagnosed with trimalleolar fracture and had fixated their posterior malleolar by us. And by that, it was detected that posterior malleolar stabilization affects positively on ankle's functional score. CONCLUSIONS During surgical treatment of ankle fractures; the full length of fibula should be ensured, rigid external fixation should be performed with the aim of anatomical reduction of the articular surface, and the ankle movement should be provided soon. KEYWORDS: Adult, ankle fracture, surgical treatment of ankle fracture