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Updated: Mar 24, 2026
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Published on: January 24, 2018
Outcomes Over a Decade After Surgery for Unstable Ankle Fracture: Functional Recovery Seen 1 Year Postoperatively
Deirdre K Regan1, Stephen Gould, Arthur Manoli
1*Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, NY; †UAB Department of Orthopaedic Surgery, UAB Orthopaedic Clinic, Birmingham, AL; and ‡Department of Orthopaedic Surgery, Jamaica Hospital Medical Center, Jamaica, NY.
Objectives:
To evaluate long-term clinical and radiographic outcomes after surgical fixation of unstable ankle fractures.
Design:
Prospective follow-up study.
Setting:
Academic medical center with 2 Level-I trauma centers and a tertiary care center.
Patients:
One hundred forty-one patients who underwent surgical repair of an unstable ankle fracture.
Intervention:
Open reduction internal fixation of an unstable ankle fracture.
Main Outcome Measurements:
Short Musculoskeletal Function Assessment (SMFA) scores and radiographic outcomes based on the van Dijk criteria at a mean of 11.6 years follow-up.
Results:
Of the 281 patients meeting the inclusion criteria for this study, follow-up data were obtained from 141 patients (50%), at a mean of 11.6 years after surgery. Overall, mean long-term SMFA scores were improved when compared with scores at 1 year. The American Society of Anesthesiologists class 1 or 2 was found to be a significant predictor of recovery based on SMFA scores. Sixty-three percent of follow-up radiographs demonstrated evidence of radiographic arthritis, including 31% with mild osteoarthritis, 22% with moderate osteoarthritis, and 10% with severe osteoarthritis. Fracture dislocation at injury was found to be a significant predictor of radiographic posttraumatic osteoarthritis at latest follow-up. One patient (0.7%) underwent a tibiotalar fusion secondary to symptomatic posttraumatic arthrosis. One patient (0.7%) underwent total ankle replacement due to severe osteoarthritis.
Conclusions:
Our data indicate that over a decade after ankle fracture fixation, most of the patients are doing well. Despite the presence of radiographic arthritis in 63% of patients, few experience pain or have restrictions in function, and mean long-term functional outcome scores are improved when compared with scores at 1 year. Patients undergoing operative fixation of unstable ankle fractures can anticipate functional outcomes that are maintained over time.
Level Of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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