Plafond Malreduction and Talar Dome Impaction Accelerates Arthrosis After Supination-Adduction Ankle Fracture

Abstract

Background: Supination-adduction (SAD) type II ankle fractures can have medial tibial plafond and talar body impaction. Factors associated with the development of posttraumatic arthritis can be intrinsic to the injury pattern or mitigated by the surgeon. We hypothesize that plafond malreducton and talar body impaction is associated with early posttraumatic arthrosis. Methods: A retrospective cohort of skeletally mature patients with SAD ankle fractures at 2 level 1 academic trauma centers who underwent operative fixation were identified. Patients with a minimum of 1-year follow-up were included. The presence of articular impaction identified on CT scan was recorded and the quality of reduction on final intraoperative radiographs was assessed. The primary outcome was radiographic ankle arthrosis (Kellgren-Lawrence 3 or 4), and postoperative complications were documented. Results: A total of 175 SAD ankle fractures were identified during a 10-year period; 79 patients with 1-year follow-up met inclusion criteria. The majority of injuries resulted from a high-energy mechanism. Articular impaction was present in 73% of injuries, and 23% of all patients had radiographic arthrosis (Kellgren-Lawrence 3 or 4) at final follow-up. Articular malreduction, defined by either a gap or step >2 mm, was significantly associated with development of arthrosis. Early treatment failure, infection, and nonunion was rare in this series. Conclusion: Malreduction of articular impaction in SAD ankle fractures is associated with early posttraumatic arthrosis. Recognition and anatomic restoration with stable fixation of articular impaction appears to mitigate risk of posttraumatic arthrosis. Investigations correlating postoperative and long-term radiographic findings to patient-reported outcomes after operative treatment of SAD ankle fractures are warranted. Level of Evidence: Level IV, retrospective case series.

Measuring external rotation of the fibula and fibular length in bilateral CT scans: how reliable is this method?

“…13 A postoperative computed tomography (CT) scan is advised in cases of doubt regarding the quality of reduction. 14,15 Measuring the accuracy of tibiofibular reduction has been challenging, but bilateral postoperative CT imaging is a commonly used method. [16][17][18] The use of CT is more sensitive compared with the use of conventional radiographs.…”

“… 13 A postoperative computed tomography (CT) scan is advised in cases of doubt regarding the quality of reduction. 14 , 15 …”

Significant Factors of High Performance Outcomes for Tibial Plafond Fractures

“…These injuries often result in life-altering disability and reduced quality of life from wound slough, infection, stiffness, deformity, and post-traumatic arthritis that can result in subsequent ankle arthrodesis, amputation, and ankle replacement. 11,14,15,21,30 To determine return to function following these injuries, several patient-reported outcome measures (PROMs) have been developed to evaluate various domains of patient function. Patient Reported Outcome Measurement Information System (PROMIS) physical function (PF) computer adaptive testing (CAT) has been more recently implemented in clinical settings and has demonstrated to be a reliable indicator of outcome.…”