Radiological And Functional Outcome of Closed Ankle Fractures Treated By open Reduction And Internal Fixation
Journal Title: IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) - Year 2017, Vol 16, Issue 2
Abstract
To evaluate clinically and radiologicalliy the type of injury and to analyze the results of closedbimalleolar ankle fractures treated withopen reduction and internal fixation. This is prospective study done at Sri Ramachandra University, Chennai 2013to assess the functional and radiological outcome of closed bimalleolar ankle fractures treated by open reduction and internal fixation. The duration of study was 18 months with a minimum follow up of 3 months to a maximum of 18 months. (Avg-12 months). Total number of Patients assessed and evaluated in this study were 30. Patients were followed clinicallyand radiologically evaluated at 6 weeks, 12 weeks, 24 weeks and thereafter, every year. Post-Operative evaluation of function and radiological outcome was done using the Baird and Jackson scoring system. This score is based on the criteria ofpain, stability of ankle, ability to walk, run and do work, ankle movements and radiological analysis.Based on the Baird and Jackson scoring system, we graded our results as Excellent, Good, Fair and Poor. Our results wereExcellent in 9 Cases (30%), Good in 11 Cases (37%), Fair in 4 Cases (13%) and Poor in 6 Cases (20%). After open reduction, the medial malleolus was fixed using an implant based on type of fracture and the soft tissue condition. Maximum medial malleoli fixation was done using cancellous screws alone (57%) and tension band wiring (27%).After open reduction, the Lateral malleolus was fixed using an implant based on type of fracture and the soft tissue condition.Maximum lateral malleoli fracture fixations done using plate fixation (84%). Fewer cases were fixed with tension band wiring and K-Wire. One case was left unfixed and was immobilized using a below knee POP slab for 3 weeks.A syndesmotic screw was needed to stabilize the syndesmotic joint for 3 cases. Posterior malleolus needed operative fixation in 2 cases. All Patients were evaluated pre-operatively by clinical and radiologicalmethods. The Fracture patterns were classified by the mechanism of injury described by Lauge – Hansen. Our study showed a predominance of Supination – External Rotation injuries (33%) followed by Pronation - External Rotation (27%), Pronation – Abduction (23%) and 17% of supination – adduction injury. Immediate open Reduction and Internal Fixation in ankle fractures yield good results in terms of anatomical reduction, stability and Post Op functional return. Supination External Rotation injury is the commonest mechanism of injury in our study.Patient operated early, only if soft tissue was good,in order to have good functional outcome in closed ankle fractures. Delay in surgery tended to give a poorer result.Good control of comorbidities decreased Post Op complications.Early return of ankle movements Post OP with proper rehabilitation improved functional outcome19.After a year of surgery, most patients experience little or mild pain and have certain restrictions of functional activities. Patients who needed syndesmotic joint operative stabilization, had poorer outcomes at the end of one year as compared to those that needed fixation of only bimalleolar fractures.
Authors and Affiliations
Dr. Sandesh Reddy Yaratapalli, Dr. M. R. Thirunthaiyan, Prof. R. Dorai Kumar
Keywords
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