Patient reported outcomes after revision ankle fixation.

Area of Science:

• Orthopedic surgery
• Traumatology
• Radiology

Background:

• Functional outcomes in ankle fractures depend on joint congruity, alignment, and stability.
• Revision surgery is indicated when initial surgical fixation fails to restore these parameters.
• This study evaluates revision ankle fracture fixation and a CT-based modified Pettrone score for assessing primary fixation quality.

Purpose of the Study:

• To report outcomes of revision ankle fracture fixation in a consecutive patient series.
• To describe and validate a CT scan-based modified Pettrone score for assessing primary fixation quality.
• To correlate fixation quality with functional outcomes.

Main Methods:

• Retrospective review of fourteen patients undergoing revision ankle fracture fixation (April 2019 - August 2021).
• Intra-operative radiographs and CT scans were used for assessment.
• A CT scan-based modified Pettrone score was applied to evaluate primary fixation quality.
• Demographic, clinical, radiological, and patient-reported outcome measures (Olerud-Molander Ankle Score, EQ-5D-3L VAS) were collected.

Main Results:

• Twelve patients had Lauge-Hansen protonation type injuries; syndesmotic fixation was performed in eleven.
• The mean time between surgeries was 46 days.
• The mean Olerud-Molander Ankle Score was 58, with 60% reporting good to excellent results.
• Mean EQ-5D-3L VAS score was 69, indicating satisfactory quality of life.

Conclusions:

• Early consideration of revision fixation is recommended for inadequate primary ankle fracture fixation.
• The modified Pettrone criterion, assessed via CT scan, is a valuable tool for identifying sub-optimal primary fixation.
• Timely intervention can lead to improved functional outcomes and quality of life.