Prediction of Outcome After Ankle Fracture

Abstract

Mark Stewart, MPH (Hons)3Study Design: Prospective inception cohort study of 62 consecutive patients seen in 2 orthopaedic clinics following ankle fracture. Objectives: To investigate 4 putative predictors (age, fracture classification, acute management [surgical or nonsurgical], and ankle dorsiflexion range of motion measured at the time of cast removal) of outcome after ankle fracture and to develop simple predictive models of outcome after ankle fracture. Background: Ankle fracture is a common condition. However, few studies have investigated factors that predict outcome after ankle fracture. Methods and Measures: Sixty-two consecutive subjects aged 17 or older with ankle fractures were recruited from 2 hospital orthopaedic clinics. Outcome measures recorded at 6 weeks and 6 months after cast removal included 2 functional questionnaires, patients' ratings of global improvement, and a measure of ankle dorsiflexion. The predictive value of 4 variables selected a priori was analyzed using bivariate and stepwise multiple linear regression. Results: Ankle dorsiflexion and fracture classification predicted outcome 6 weeks and 6 months after cast removal for all outcome measures used (P Ͻ .05, r 2 = 0.09-0.47). Fracture management (surgical or nonsurgical) inconsistently predicted outcome at both 6 weeks and 6 months, and age did not predict outcome at either 6 weeks or 6 months after cast removal. The predictive models explain between 19% and 58% of the variance in outcomes 6 weeks after cast removal and 19% to 52% of the variance in outcomes 6 months after cast removal. Conclusion: Ankle dorsiflexion measured at the time of cast removal and fracture classification are clinically significant predictors of outcome after ankle fracture; however, much unexplained variation in outcomes still exists. J Orthop Sports Phys Ther 2005;35:786-792.

Functional Outcome Following Operative Treatment of Ankle Fractures

“…18 Shivarathre et al in 2011 studied the results of operative fixation for unstable ankle fractures in patients aged over 80 years. The most common fracture pattern was Danis-Weber B type.…”

Evidence-based treatment for ankle injuries: a clinical perspective

“…Factors found to be associated with outcomes after ankle fracture include the type of orthopedic management (surgical or conservative), 11,[53][54][55][56][57] fracture severity, 11,54,[58][59][60][61][62][63][64] ankle range of motion, 54,65 Classifying fracture severity according to the number of malleoli fractured appears to provide a more reliable prediction of outcome. Unimalleolar fracture has been consistently shown to be associated with better outcomes than bimalleolar or trimalleolar fracture.…”

“…Unimalleolar fracture has been consistently shown to be associated with better outcomes than bimalleolar or trimalleolar fracture. 54,58,60,62 There is also some indication that baseline ankle dorsiflexion range of motion and pain are independent predictors of function, perceived recovery, and dorsiflexion range of motion in the short and medium term. 54,65 However, further research is required to investigate whether modifying these factors, or selectively providing patients with significant problems in dorsiflexion range of motion and pain with a more intensive rehabilitation program, will lead to better outcomes.…”

Reliability and Validity of a Weight-Bearing Measure of Ankle Dorsiflexion Range of Motion

“…In addition, the cross-sectional correlations between LT Aff and the LEFS in our study are similar to those reported for patients with an ankle fracture after cast removal (95% CIs for r ¼ 0.07-0.21 at 6 weeks and 0.05-0.20 at 6 months). 1 As Table 3 shows, the validity findings suggest a measurement strategy that may minimize clinical time spent measuring DF-ROM. The absence of a cross-sectional relationship between LT Aff and LEFS and GFAS scores, in the presence of a longitudinal relationship between their change scores, suggests that measurement of LT Aff is a valid means of documenting change.…”

“…19 Among patients with an ankle fracture, two studies have demonstrated the predictive validity of affected-limb LT scores on activity limitation. 1,20 The present study was designed as an initial parameter estimation study of the psychometric properties of the LT in a sample of orthopaedic patients. Our objectives were to examine the reliability and validity of the LT and to determine the impact on these measurement properties of using a single or multiple series of lunges with one or both limbs.…”