78 - Freie Mitteilung
16. Mai 2019, 17:30 - 19:00, Sopra 3, 4. OG
Functional outcome using specific provocation tests after osteosynthesis of lateral ankle fractures
J. Zimmermann1, L. Zingg1, T. Marth1, W. O. Frey2, B. Ernst1, P. Lenzlinger1, A. Babians1, U. Zingg1, Presenter: J. Zimmermann1 (1Schlieren, 2Zürich)
The incidence of ankle fractures is high, and around 55% occur laterally. The treatment of unstable fractures consists of open reduction and internal fixation (ORIF), followed by physiotherapy. Despite the high incidence, data on functional outcome is scarce. The present study examined a cohort of patients with Weber B malleolar fractures in comparison to healthy controls, with a focus on functional outcome using specific provocations tests, as well as clinical and radiological assessments.
All patients with ORIF of a Weber B fracture between 2012 and 2016 were asked to participate. Inclusion criteria included age 18-50, a minimum of 2 years after ORIF or 1 year after plate removal. This cohort was age and gender matched to a healthy control. The provocation tests included forced dorsal extension, Y-balance, Dropjump, Tiptoe and Legpress tests, respectively. For the clinical assessment the SF-36 and the foot and ankle ability measure (FAAM) questionnaires were used. X-rays of the operated and the healthy ankle were taken.
22 patients were recruited, and compared to 33 healthy persons. There were no significant differences in basic descriptives, except for the supporting leg being more often on the right side [30 (90.1%) vs. 12 (54.5%), p=0.002] and less individuals performing regular sports activities in the control [6 (19.4%) vs. 10 (47.6%)]. 18 patients (81.8%) had undergone hardware removal. The provocation tests showed no significant differences, with exception of the forced dorsal extension: control 13 cm vs. patients 10.5 cm, p=0.025. The range of motion and the legpress were tested separately for the operated and non-operated ankle of the patients, and showed no significant difference. The SF-36 questionnaire revealed significant lower scores in patients in 5 sections. The FAAM questionnaire revealed significantly better results in the control group (1.00 vs. 0.95, p=0.001). Radiological assessment of the operated and non-operated ankle demonstrated less width of the syndesmosis in the former (4.60mm vs. 4.84mm, p=0.0495). 4 patients (18.4%) had early signs of arthrosis, with no clinical symptoms.
ORIF of lateral malleolar fractures type Weber B results in excellent objective results. However, some functional impairment with regard to range of motion may persist and patients may experience some subjective impairment in comparison to healthy controls.