Journal of Orthopaedic Diseases and Traumatology (May 2024)
Functional Outcome of Bimalleolar Ankle Fractures – A Prospective Study
Abstract
Background: Ankle fracture ranks second among lower limb fractures, accounting for about 10% of all fractures. It occurs in about 137 per 1 lakh people each year. Bimalleolar fractures are the most common fracture in outpatient as well as in emergency department which accounts for 1/4th of all ankle fractures. Treatment of this fracture is complicated and challenging as the outcome will influence the locomotive power. Improper and inadequate fixation will cause long term disability as the body weight is transmitted through the ankle joint. This study was conducted to evaluate the functional outcome of bimalleolar ankle fractures treated with various surgical modalities. We also try to delineate the types of fractures occurred and its outcome after surgical fixation and also to understand the advantages and disadvantages of various implants used along with its complications. Aims and Objectives: To determine the functional outcome of surgical management of bimalleolar ankle fractures and to know the risks and complications associated with surgical fixation of bimalleolar ankle fractures. Subjects and Methods: A prospective study is conducted among 40 patients who came to the Emergency Department and to Orthopaedics Outpatient Department in Sree Mookambika Institute of Medical Sciences between April 2021 and September 2022 were analyzed. We have included bimalleolar ankle fractures with Lauge–Hansen classification (SER4, SAD 2, PER 3, PAB 3), Danis–Weber Type (A2, B2, C2, C3) in this study and we have excluded patients with Lauge–Hansen classification (SER1,2,3, SAD1, PER1,2,4, PAB1,2), Danis-Weber Type (A1, A3, B1, B3, C1), Systemic infections, open injury, fracture with dislocation, skin diseases over the incision site Trimalleolar ankle fracture, previous arthrodesis at target level. Based on the fracture pattern, the patients were planned for surgical fixation with appropriate implants. Results: In our present study of 40 patients, we assessed the functional outcome based on Baird and Jackson’s scoring system. Based on which 21 patients (52.5%) had excellent outcome, 14 patients (35%) had good outcome, 3 patients (7.5%) had fair outcome, and 2 patients (5%) had poor outcome. Out of total population, 35 patients (87.5%) had no complications followed by 3 patients (7.5%) had superficial infection and 2 patient (5%) who had ankle stiffness. Conclusion: Medial malleolus fracture can be effectively treated by various modalities such as Screw fixation, tension band wiring (TBW) and K-wire fixation, giving excellent to good results. Among which TBW and Screw fixation are relatively better than K-wire fixation for medial malleolus fracture. Similarly, lateral malleolus fracture can be treated with plate fixation, screw fixation and K-wire fixation which gives excellent to good results. Among which plate fixation (locking compression plate) is better than K-wire and screw fixation for lateral malleolus fracture. Superficial skin infection is the most common complication we encountered in our study.
Keywords
