Stability-Based Classification of Ankle Fractures—The Long-Term Outcome After 11–13 Years of Follow-up

Karkkola, Sini; Kortekangas, Tero; Pakarinen, Harri; Flinkkilä, Tapio; Niinimäki, Jaakko; Leskelä, Hannu-Ville

doi:10.1097/bot.0000000000001959

Cited by 4 publications

(4 citation statements)

References 61 publications

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“…This was confirmed as all the X-rays showed an anatomical reduction and a fully healed fracture. Most patients, including those in the control group, Zimmermann et al Journal of Orthopaedic Surgery and Research (2024) 19:327 had medial and lateral clear spaces symmetrically smaller than 4 mm, which might be one radiological sign of developing arthritis according to van Dijk and Scranton [18,[50][51][52]. However, no other signs of arthritic changes, such as osteophyte formation, subchondral sclerosis or subchondral cysts, were observed.…”

Section: Discussionmentioning

confidence: 93%

Clinical, functional and radiological outcome after osteosynthesis of ankle fractures using a specific provocation test

Zimmermann,

Zingg,

Frey

et al. 2024

J Orthop Surg Res

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Background Ankle fractures are frequent, and despite numerous publications on their treatment and outcome, there is a lack of precise data on the functional results in young, healthy and physically active patients. We hypothesized that patients who underwent open reduction and internal fixation (ORIF) for simple ankle fractures would have similar function compared to a healthy control group, whereas patients with complex fractures will have significant functional deficits. Furthermore, we postulate that there is a discrepancy between the radiological and the functional outcomes. Methods A set of specific provocation tests was developed to evaluate the postoperative possibility of weight bearing, stop-and-go activities and range of motion. In combination with three questionnaires and a radiographic evaluation, the true functional outcome and the possibility of participating in sporting activities were investigated and compared with those of an age- and sex-matched control group. Results A significant impairment was found in unilateral and simple ankle fractures. This impairment increased in tests including stop-and-go activities in combination with load bearing and with the complexity of the fractures. Concerning the subjective outcome, there was a significant adverse effect for daily activities without any difference in preoperative or postoperative sporting activity between the groups. No difference was found in the radiological assessment. Conclusions Both simple and complex ankle fractures treated with ORIF have a significant and long-lasting impact on functional outcome in young and active patients. The radiological result is not associated with a good functional outcome. Trial registration BASEC-Nr. 2018 − 01124.

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Section: Discussionmentioning

confidence: 93%

Clinical, functional and radiological outcome after osteosynthesis of ankle fractures using a specific provocation test

Zimmermann,

Zingg,

Frey

et al. 2024

J Orthop Surg Res

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“…This is one of the longest RCT follow-up of patients with a type 44B1 ankle fracture treated with or without surgery. Karkkola et al 10 reported on similar numbers in their assessment of stable and unstable ankle fractures over a 12-year period; however, this was a retrospective study.…”

Section: Strengths and Limitationsmentioning

confidence: 88%

Minimum 5-Year Follow-up Results: CROSSBAT (Combined Randomised and Observational Study of Surgery vs No Surgery for Type B Ankle Fracture Treatment)

et al. 2022

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Background: Isolated Weber B, AO (Association for the Study of Internal Fixation) type 44B ankle fractures with no fracture to the medial side are the most common type of ankle fracture and may be treated with internal fixation or without surgery. This study aimed to determine if surgery is superior to nonsurgical management for the treatment of these fractures after a minimum 5-year follow-up. Methods: Design: A pragmatic, multicenter, single-masked, randomized controlled trial with minimum 5-year follow-up. Setting/participants/interventions: Participants between 18 and 65 years with AO type 44B ankle fracture and minimal talar shift were recruited from 22 hospitals in Australia and New Zealand. Participants willing to be randomized were randomly allocated to undergo surgical fixation followed by mobilization in a walking boot for 6 weeks. Those treated nonsurgically were managed in a walking boot for 6 weeks. Outcome assessors were masked for the treatment allocation. Primary outcomes: Patient-reported ankle function using the American Academy of Orthopaedic Surgeons Foot and Ankle Outcomes Questionnaire (FAOQ) and the physical component summary (PCS) of the SF-12v2 General Health Survey at 12 months postinjury and at minimum 5 years post injury. Primary analysis was intention-to-treat. Results: Of the 160 (80 surgical, 80 nonoperative) randomized patients included in the CROSSBAT analysis, 77 (40 surgical, 37 nonoperative) were followed up for repeat analysis at minimum 5-year follow-up (mean 7.3 years, range 5.1-8.9). This cohort demonstrated that surgery was not associated with clinically or statistically significant differences compared to nonoperative management for the FAOQ (51.7 vs 49.6; mean difference 2.1, 95% CI –2.1 to 6.2, P = .95), or the PCS (51.5 vs 49.1; mean difference 2.3, 95% CI –2.0 to 6.7, P = .54). The surgical cohort had a higher rate of any adverse events (odds ratio 3.7, 95% CI 1.2-11.6, P = .04). Conclusion: The results of this study suggest that surgical management is not superior to nonsurgical management in type B ankle (fibula) fractures with minimal talar shift over a 5-year period and is associated with increased adverse events. Level of Evidence: Level II, randomized clinical trial.

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“…Most patients, including the control group, showed medial and lateral clear spaces symmetrically smaller than 4 mm, which might be one radiological sign of developing arthritis according to van Dijk and Scranton. [15,[46][47][48] However, no signs of arthritic changes such as osteophyte formation, subchondral sclerosis or subchondral cysts were seen.…”

Section: Discussionmentioning

confidence: 99%

Clinical, functional and radiological outcome after osteosynthesis of ankle fractures using a specific provocation test

Zimmermann,

Zingg,

Frey

et al. 2024

Preprint

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Background Ankle fractures are frequent and despite numerous publications on its treatment and outcome, there is a lack of precise data on the functional results in young, healthy and sportive patients. We hypothesized that patients after open reduction and internal fixation (ORIF) of a simple ankle fracture would have a similar function compared to a healthy control group, whereas patients with complex fractures will have significant functional deficits. Furthermore, we postulate that there is a discrepancy between the radiological and the functional outcomes. Methods Therefore, a specific provocation test has been developed to evaluate the postoperative possibilities of weight bearing, stop-and-go activities and range of motion during extremes of movements. In combination with three questionnaires and a radiographic evaluation the true functional outcome and the possibility of participating in sportive activities has been investigated and compared with an age and sex matched control group. Results A clear impairment even in unilateral and simple ankle fractures has been found. Impairment increased in tests including stop-and-go activities in combination with load bearing and with the complexity of the fractures. Concerning the subjective outcome there was a significant impairment in daily activities without any difference in preoperative and postoperative sportive activity between the groups. No difference was found in the radiological assessment. Conclusions The study shows the need of more complex functional evaluation in young and sportive patients after open reduction and internal fixation of an ankle fracture. Trial registration: BASEC-Nr. 2018 − 01124

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Stability-Based Classification of Ankle Fractures—The Long-Term Outcome After 11–13 Years of Follow-up

Abstract: Objectives: To assess the long-term functional and radiological outcome, as well as complications and reoperations of ankle fracture patients treated based on stability classification.Design: Retrospective.

Cited by 4 publications

References 61 publications

Clinical, functional and radiological outcome after osteosynthesis of ankle fractures using a specific provocation test

Clinical, functional and radiological outcome after osteosynthesis of ankle fractures using a specific provocation test

Minimum 5-Year Follow-up Results: CROSSBAT (Combined Randomised and Observational Study of Surgery vs No Surgery for Type B Ankle Fracture Treatment)

Clinical, functional and radiological outcome after osteosynthesis of ankle fractures using a specific provocation test

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