Functional outcomes 2 years after surgical treatment of ankle fractures: A cohort study

Ankle fractures are a common type of fracture. Knowledge of functional outcomes are important for patient counseling and expectation management. The aim of this study is to evaluate the functional outcome after surgically treated ankle fractures and which patient, fracture and treatment characteristics are related to the midterm functional outcome after surgical fixation of ankle fractures.

Between August 2016 and May 2020, patients who were surgically treated for an ankle fracture in one of four participating hospitals were included. Patient, fracture and treatment characteristics were retrieved from medical records. After medical follow-up, patients were questioned about their functional outcome using the Lower Extremity Functional Scale (LEFS) questionnaire. Predictive factors for functional outcome were calculated by doing a linear regression analysis using SPSS.

A total of 552 patients were included in this study. The median follow-up time was 2.3 years (IQR 544-1116 days) after injury, with a median LEFS of 66.40 (53.60-75.20) points. Fracture characteristics (Weber classification or Gustilo classification) were not seen as a significant predictor for the LEFS. Higher age, higher BMI, higher ASA classification, trimalleolar fixation and complications were found to be significant independent predictors of lower LEFS.

Two years after a surgically treated ankle fracture fewer than 25 % of the patients achieve the median functional score observed in the healthy Dutch population. In this study age, BMI, ASA classification, extensive surgical fixation and postoperative complications are the most important significant independent predictors of a lower functional outcome.