[Long-term outcomes after ankle fracture-Where do we stand?]

With an incidence of approximately 74 per 100,000 people per year, ankle fractures are among the most frequent fractures in adults and are considered a major cause of posttraumatic ankle osteoarthritis. Reliable long-term data (≥ 10 years) are scarce. The aim of this study was to review the existing literature regarding long-term treatment outcomes following surgical management of ankle fractures. A narrative literature review was conducted. Studies were identified that reported on the treatment outcomes of surgically managed ankle fractures with a follow-up period of at least 10 years. A total of 20 studies with a mean follow-up period of 12.9 years were identified. On average the long-term outcomes were good to very good; however, depending on the patient population and scoring system 11-30% of patients reported only moderate to poor outcomes. Moderate to severe osteoarthritis was radiologically found in 18-100% of cases, although it was often asymptomatic. The conversion rate to arthrodesis or endoprosthesis ranged from 0-3% across all studies. Across the studies, only fracture complexity, development of osteoarthritis over time and depression had an impact on the outcome. In our own cohort, the number of fractured malleoli was the only significant influencing factor. Overall, the quality of the studies was at times unsatisfactory and, above all, comparability was limited. In the future, a standardization of the parameters collated would be valuable in order, for example, to evaluate the effectiveness of different surgical procedures across multiple studies.