[Significance of concomitant injuries in malleolar fractures. A prospective study]

The objective of this prospective study was to determine clinical and radiological results 2 years after ankle fractures and to compare them with preoperative arthroscopic findings. Of 135 consecutive patients undergoing osteosynthetic treatment, 128 (type A, 2; type B, 97; type C, 29) were reviewed 2 years later. The Kitaokascore for functional and clinical rating and the Kannusscore for radiological rating were used. Initial cartilaginous lesions localized on the medial malleolus led to poor clinical ratings (P < 0.01) and cartilaginous lesions of the pilon tibiale and talus caused poor radiological results (P < 0.032 and P < 0.046). After rupture of the deltoid ligament, more pain was observed (P < 0.038). Rupture of the syndesmosis, however, did not affect the outcome. Clinical outcome was poor among the 30- to 65-year-old patients. The clinical and radiological outcome of women was poorer (P < 0.018 and P < 0.046) than for men. The older the patients, the more radiological signs of arthritis were found. The outcome of ankle fracture seems to correlate significantly with the nature, dimension and localization of fracture-associated cartilaginous and ligament lesions. Age and sex also seem to play a significant role in the outcome.