Management of Neglected and Malunited Ankle Fractures

Abstract

Abstract Background Ankle fractures are very frequent and they can present a variety of clinical features. Dislocated or unstable ankle fractures are generally treated with surgical anatomical reduction and internal fixation. Most of these fractures heal very well. However, some of these fractures fail to reduce and become malunited. Early biomechanical studies have demonstrated that lateral talar shift greater than 1mm may cause a loss of over 40% of the tibiotalar contact area. Aim of the Work The aim of the treatment is to obtain an ankle with normal alignment and function which exhibits no pain with preventing any degenerative changes that may take place in the future. Surgical options include refixation of non-united medial or lateral malleolus, lengthening of fibula, repair of neglected syndesmotic injury, and repair of other ligamentous injury. Patients and Methods Our study included 30 patients with malunited ankle fractures. The outcomes were compared pre and post operatively. The Inclusion criteria were patients with malunited or neglected ankle fractures, both sexes and Age between 20 – 60 years old. While, Exclusion criteria were patients suffering from peripheral vascular insufficiency, advanced ischemia, peripheral neuropathy, advanced tibiotalar osteoarthritis, soft tissue compromise, stiff ankle, infected non-union and skeletally immature patients. Results The AOFAS in patient with syndesmotic affection showed improvement from mean±SD 48.35±12.99 preoperatively to 82.71±10.32 postoperatively, while in patients with non syndesmotic affection showed improvement from 60.46±18.91 preoperatively to 86.77±20.79 post operatively. This means that this is significant increase in AOFAS score in both groups but its more obvious among patients with syndesmotic affection. The FAAM score in patient with syndesmotic affection showed improvement from mean±SD 46.47±15.96 preoperatively to 82.41±8.05 postoperatively, while in patients with non syndesmotic affection showed improvement from 54±18.96 preoperatively to 79.77±16.45 post operatively. It means that there is increase in FAAM score in both groups but its more significant among patients with syndesmotic affection. The FADI score among patients was mean±SD 49.87±11.39 preoperatively and 77.07±11.89 two years postoperative, there was statistically significant higher mean value of FADI in follow up compared to pre-operative. Conclusion There is statistically significant improvement in functional and radiological outcomes in patients with syndesmotic affections more than patients with non syndesmotic affection.