Factors influencing articular function after surgery for ankle fractures

Abstract

Objective To analyze the factors that influence the articular function after open reduction and internal fixation for ankle fractures. Methods From July 2014 to January 2016, 111 ankle fractures received surgery in our hospital. There were 54 males and 57 females, with a mean age of 43.5 years (from 18 to 75 years). By the Broos & Bisschop classification, there were 43 unimalleolar, 38 bimalleolar and 30 tri-malleolar fractures. The postoperative articular function was evaluated according to the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scoring at the final follow-up. Comparisons were made be-tween the patients with excellent functional scores and those with lower than excellent functional scores. The potential influencing factors were analyzed, including age, gender, body mass index, smoking history, primary hypertension history, diabetes history, injured side, fracture cause, Broos & Bisschop classification, combined presence of obvious inferior tibiofibular separation, combined presence of ankle dislocation, combined presence of other injury, time from injury to surgery, physical status classification by the American Society of Anes-thesiologists system, operation time, early functional exercise, removal of internal fixation and postoperative complications. The influencing factors were identified using univariate analysis and logistic regression analysis. Results The average follow-up period was 15.5 months (from 8 to 25 months). The clinical union time of the fractures averaged 3.2 months (from 3 to 5 months). The ankle function at the final follow-up was excellent in 58 cases, good in 48, fair in 5 and poor in 0, with an excellent and good rate of 95.5%. Removal of internal fixation (P=0.001), early functional exercise (P=0.002), and postoperative complications (P=0.049) were identified as the independent risk factors influencing the articular function after surgery for ankle fractures. Conclusion For patients with ankle fracture, enhancing intraoperative procedures, reducing postoperative complications, encouraging the patients to do early functional exercise, and removing internal fixation after fracture union can effectively improve their ankle function. Key words: Ankle joint; Fractures, bone; Fracture fixation, internal; Logistic models; Prognosis