Ahmed, R. orcid.org/0000-0003-1758-2708, Ward, A.E. orcid.org/0000-0002-9609-830X and Thornhill, E. (2024) Patient-reported outcomes and prognostic factors in ankle fracture-dislocation: a systematic review. Trauma, 26 (2). pp. 113-123. ISSN 1460-4086
Abstract
Objectives
Ankle fractures have an incidence of around 90,000 per year in the United Kingdom. They affect younger patients following high energy trauma and, in the elderly, following low energy falls. Younger patients with pre-existing comorbidities including raised BMI or poor bone quality are also at risk of these injuries which impact the bony architecture of the joint and the soft tissues leading to a highly unstable fracture pattern, resulting in dislocation. At present, there is no literature exploring what effect ankle fracture-dislocations have on patients’ quality of life and activities of daily living, with only ankle fractures being explored.
Methods
Relevant question formatting was utilised to generate a focused search. This was limited to studies specifically mentioning ankle injuries with a focus on ankle fracture-dislocations. The number of patients, fracture-dislocation type, length of follow up, prognostic factors, complications and outcome measures were recorded.
Results
Nine hundred and thirty-nine fractures were included within the studies. Eight studies looked at previously validated foot and ankle scores, two primarily focused on the American Orthopaedic Foot and Ankle Society score (AOFAS), three on the foot and ankle outcome score (FAOS), and one study on the Olerud–Molander score (OMAS). Patient, injury, and management factors were identified as being associated with poorer clinical outcomes.
Conclusions
Not only are age and BMI a risk factor for posttraumatic osteoarthritis but they were also identified as prognostic indicators for functional outcome in this review. Patients sustaining a concurrent fracture-dislocation were found to have poorer clinical outcomes, and the timing and success of reduction further influenced outcomes. This review found that the quality of reduction was directly related to the patients’ functional outcomes post-follow up, and the risk of developing posttraumatic osteoarthritis, which was more frequent in patients sustaining Bosworth fractures, posterior malleolar fractures, and in patients with increasing age.
Level of evidence
IV.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2023 The Author(s). This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is properly attributed. |
Keywords: | Ankle fracture; ankle fracture dislocation; open fracture; open reduction internal fixation; American Orthopaedic Foot and Ankle Society score; Olerud–Molander foot and ankle score; posttraumatic osteoarthritis; prognostic factor; outcome |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > The Medical School (Sheffield) > Academic Unit of Medical Education (Sheffield) |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 01 May 2024 09:56 |
Last Modified: | 01 May 2024 09:56 |
Status: | Published |
Publisher: | SAGE Publications |
Refereed: | Yes |
Identification Number: | 10.1177/14604086231183582 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:212063 |