No Decay in Subjective Function Found Decade After Ankle Surgery

A long-term follow-up of patients treated with open reduction and internal fixation for unstable ankle fracture showed no decrease in function over time when compared with self-reported results one year after surgery.

“The results of our study demonstrate that the majority of patients are doing well over a decade after fracture fixation. Despite the presence of radiographic arthritis in 79 percent of patients, few experience pain or have restrictions of function,” Deirdre Regan, B.A., said.

A student on the research team at NYU Hospital for Joint Diseases, Regan conducted the study with colleagues Kenneth A. Egol, M.D.; Kenneth J. Koval, M.D.; Nirmal C. Tejwani, M.D.; Stephen Gould, M.D., M.P.H.; and Arthur Manoli III, B.S.

To determine the long-term outcomes after surgical stabilization of unstable ankle fractures, Regan and colleagues identified 150 patients who were enrolled in a prospective database and followed to one year. At the time of surgery, investigators collected patients’ American Society of Anesthesiologists (ASA) classification, fracture classification, and baseline function using Short Form Musculoskeletal Assessment (SFMA) and American Orthopaedic Foot and Ankle Society (AOFAS) scores. Patients were seen three months, six months and one year post-fixation, at which time X-rays were obtained, and SFMA and AOFAS scores were assessed. Of these patients, 75 responded to requests for clinical and radiographic follow-up. The mean age at follow-up for these patients was 58 years at a mean of 10.5 years post-fixation.

The follow-up cohort was significantly older at the time of injury compared with the original cohort. There were no other significant demographic differences between the groups.

“We found no significant difference between long-term total SMFA scores compared to scores at one year. ASA class 1 or 2 was found to be a significant predictor of recovery based on SFMA scores,” Regan said.

Overall, 84 percent of patients had either no or mild ankle pain and 91 percent had either no limitations or limitations only in recreational activities. The researchers found 59 percent of patients had AOFAS ankle-hindfoot scale scores of greater than or equal to 90 and 85 percent scored greater than 80.

Ten patients underwent hardware removal and one patient underwent tibiotalar fusion secondary to symptomatic post-traumatic arthrosis. Radiographic evidence of osteoarthritis (OA) was present in 79 percent of patients; 21 percent had no OA; 50 percent had mild OA; 25 percent had moderate OA; and 4 percent had severe OA. Male gender was a significant predictor of radiographic evidence of OA, Regan said.

“Our findings indicate that in the long term, patients treated surgically for unstable ankle fractures can expect to have similar outcomes to their status at one year following fixation,” she said.