The Effect of Initial Closed Reduction Quality on Patient Outcomes Following Ankle Fractures: A Retrospective Study

Ankle fractures are common injuries associated with significant morbidity. A significant proportion of closed ankle fractures are displaced or unstable, requiring reduction. While early near-anatomic reduction is commonly performed, it is not known whether this affects long-term outcomes. This study aims to identify the association of reduction quality with outcomes in patients with displaced, closed ankle fractures. We hypothesize that patients with anatomic reductions will have fewer complications than patients who have suboptimal reductions.

A retrospective analysis of 167 patients with ankle fractures in the emergency department was conducted. Postreduction X-rays were graded for quality of reduction, and the reducing provider was identified. Patients were grouped by quality of reduction: anatomic and suboptimal. Outcomes, including complications, surgery, and time to surgery, were compared between the groups.

One hundred thirteen (67.7%) patients had an anatomic reduction, and 54 (32.3%) had a suboptimal reduction. Patients with anatomic reduction had higher rates of reduction performed by an orthopedic provider (31.9% vs. 14.8%; p = 0.031). Patients reduced by orthopedics had less talar shift on postreduction X-rays (1.8 ± 1.9 vs. 3.3 ± 4.7; p = 0.005). There were no differences in outcomes between those with anatomic or suboptimal reduction and patients who had a reduction by orthopedics.

Reductions performed by an orthopedic provider were of higher quality; there was no difference in complications between reduction grades and providers. Additional study is needed to determine whether achieving true anatomic reduction is protective against complications and impaired functional outcomes in patients with displaced ankle fractures.