Outcomes Over a Decade After Surgery for Unstable Ankle Fracture: Functional Recovery Seen 1 Year Postoperatively Does Not Decay With Time

J Orthop Trauma. 2016 Jul;30(7):e236-41. doi: 10.1097/BOT.0000000000000571.


Objectives: To evaluate long-term clinical and radiographic outcomes after surgical fixation of unstable ankle fractures.

Design: Prospective follow-up study.

Setting: Academic medical center with 2 Level-I trauma centers and a tertiary care center.

Patients: One hundred forty-one patients who underwent surgical repair of an unstable ankle fracture.

Intervention: Open reduction internal fixation of an unstable ankle fracture.

Main outcome measurements: Short Musculoskeletal Function Assessment (SMFA) scores and radiographic outcomes based on the van Dijk criteria at a mean of 11.6 years follow-up.

Results: Of the 281 patients meeting the inclusion criteria for this study, follow-up data were obtained from 141 patients (50%), at a mean of 11.6 years after surgery. Overall, mean long-term SMFA scores were improved when compared with scores at 1 year. The American Society of Anesthesiologists class 1 or 2 was found to be a significant predictor of recovery based on SMFA scores. Sixty-three percent of follow-up radiographs demonstrated evidence of radiographic arthritis, including 31% with mild osteoarthritis, 22% with moderate osteoarthritis, and 10% with severe osteoarthritis. Fracture dislocation at injury was found to be a significant predictor of radiographic posttraumatic osteoarthritis at latest follow-up. One patient (0.7%) underwent a tibiotalar fusion secondary to symptomatic posttraumatic arthrosis. One patient (0.7%) underwent total ankle replacement due to severe osteoarthritis.

Conclusions: Our data indicate that over a decade after ankle fracture fixation, most of the patients are doing well. Despite the presence of radiographic arthritis in 63% of patients, few experience pain or have restrictions in function, and mean long-term functional outcome scores are improved when compared with scores at 1 year. Patients undergoing operative fixation of unstable ankle fractures can anticipate functional outcomes that are maintained over time.

Level of evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Publication types

  • Evaluation Study

MeSH terms

  • Academic Medical Centers
  • Adult
  • Aged
  • Ankle Fractures / diagnosis
  • Ankle Fractures / surgery*
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • Fracture Fixation, Internal / adverse effects
  • Fracture Fixation, Internal / methods*
  • Fracture Healing / physiology*
  • Humans
  • Injury Severity Score
  • Joint Instability / diagnosis
  • Joint Instability / surgery*
  • Linear Models
  • Logistic Models
  • Male
  • Middle Aged
  • Monitoring, Physiologic / methods*
  • Multivariate Analysis
  • Pain Measurement*
  • Patient Satisfaction / statistics & numerical data
  • Prospective Studies
  • Radiography / methods
  • Risk Assessment
  • Time Factors
  • Trauma Centers