Ankle fracture is associated with prolonged venous dysfunction

Abstract

Leg swelling is a significant problem following ankle fracture. Venous pump function and femoral and popliteal venous patency were assessed prospectively in 26 patients with ankle fractures requiring open reduction, internal fixation and immobilization in plaster. Functional venous volume, venous filling index (VFI), ejection volume fraction (EVF) and residual volume fraction (RVF) were measured using air plethysmography at 5 days and at 6, 12 and 18 weeks after fracture. The uninjured leg was used as a control. Popliteal and femoral venous patency was determined using duplex ultrasonography. No patient developed deep vein thrombosis during the study. At 5 days after fracture there was a significant reduction in mean(s.d.) EVF, 18.2(12.1) versus 55.9(19.5) per cent, and increase in RVF, 87.0(14.3) versus 42.5(22.2) per cent (both P < 0.001). Analogous values were similar at 6 weeks, EVF 28.5(21.2) versus 55.6(21.9) per cent, RVF 82.2(16.8) versus 48.5(23.8) per cent (both P < 0.001), and at 12 weeks, EVF 39.1(16.0) versus 60.3(14.9) per cent, RVF 64.7(18.8) versus 38.8(13.2) per cent (both P < 0.001). However, by 18 weeks there was no significant difference in venous function between fractured and control limbs. It is concluded that there is a significant and prolonged impairment in venous pump function following ankle fracture.

Venous disease is associated with an impaired range of ankle movement*

“…Tierney et al showed a significant and prolonged impairment in venous pump function (assessed using APG) following ankle fracture in the absence of significant obstruction, persisting for up to 18 weeks. 16 The association between ulcers and loss of mobility of the ankle joint was also noted by Dickson Wright in 1931 and later by Ruckley who showed that 32% of patients with ulcers had severe limitation of ankle movement but only 9% had rheumatoid arthritis. 17,18 This suggests that ankle disease alone is not the only factor involved and there may be a mechanism whereby venous hypertension leads to an ankle arthropathy.…”

Structured exercise improves calf muscle pump function in chronic venous insufficiency: a randomized trial

“…23,24 Significant venous dysfunction is present within 5 days of acute, stabilized ankle fractures, but recovers by 18 weeks. 25 Unlike reversible musculoskeletal injury, limbs with severe CVI are subjected to prolonged venous hypertension. 3,5 Short-term (6 weeks) exercise with pedal ergometry significantly improved ankle joint motion and symptoms of pain and limb swelling in an observational study from Germany.…”

The efficiency of O-(beta-hydroxyethyl)-rutosides in reducing the incidence of superficial venous insufficiency in patients with calf muscle pump dysfunction

“…Trauma to the lower extremity is commonly treated with immobilization and may also lead to reduced ROAM and causes impairment of venous function. Tierney et al 13 showed a significant and prolonged impairment in venous pump function following ankle fracture in the absence of significant venous obstruction, persisiting for up to 18 weeks. In this study, significant venous dysfunction was present within 5 days in the acute phase of the stabilized ankle after the fracture; but recovered in 18 weeks.…”