Abstract
Purpose:
To evaluate the clinical outcome of an operation with early rehabilitation from ankle fracture in accordance with the injury type.
Materials and Methods:
A total of 136 patients (70 males and 66 females) who underwent surgery and early rehabilitation for ankle fractures between December 2008 and December 2013 were retrospectively reviewed. The average age was 47.9 years, with a range of 18∼79 years. The mean follow-up period was 28.7 months, with a range of 24∼102 months. All patients were classified in accordance with the Lauge Hansen classification and anatomic fracture site. Moreover, the presence of ligament injuries were documented. A short-leg cast was applied postoperatively for two weeks; thereafter, patients began the range-of-motion exercises after cast removal. Full weightbearing was allowed at 2 weeks postoperatively. Each patient was assessed radiologically and clinically based on the Olerud-Molander score, visual analogue scale (VAS) for pain, joint stiffness, and capability of single heel raising.
Results:
Seventeen patients (12.5%) complained of postoperative pain (VAS score 1∼3), and the incidence was higher in patients with trimalleolar fractures or associated ligament injuries. Twenty-three patients (16.9%) complained of postoperative ankle stiffness. The mean Olerud-Molander score was 75.4/80 (range, 55∼80). Olerud-Molander scores were lower in patients with ligament injuries than in those with fracture alone. There was no nonunion or fracture displacement even after early weightbearing walking.
Conclusion:
In this retrospective series, early rehabilitation after surgical restoration of ankle mortise by anatomical reduction and stabilization was shown to be successful. Earlier motion exercise and weightbearing walking can minimize fracture complications like joint stiffness or weakness in ankle fracture.
REFERENCES
1.Cho HO., Kwak KD., Cho SD., Lee SR. Factors affecting the outcome of the ankle fractures. J Korean Orthop Assoc. 1991. 26:1654–9.
2.Cedell CA. Ankle lesions. Acta Orthop Scand. 1975. 46:425–45.
3.Brodie IA., Denham RA. The treatment of unstable ankle fractures. J Bone Joint Surg Br. 1974. 56:256–62.
4.Burwell HN., Charnley AD. The treatment of displaced fractures at the ankle by rigid internal fixation and early joint movement. J Bone Joint Surg Br. 1965. 47:634–60.
5.Olerud C., Molander H. Bi- and trimalleolar ankle fractures operated with nonrigid internal fixation. Clin Orthop Relat Res. 1986. 206:253–60.
6.Thomas B., Yeo JM., Slater GL. Chronic pain after ankle fracture: an arthroscopic assessment case series. Foot Ankle Int. 2005. 26:1012–6.
7.Pettrone FA., Gail M., Pee D., Fitzpatrick T., Van Herpe LB. Quantitative criteria for prediction of the results after displaced fracture of the ankle. J Bone Joint Surg Am. 1983. 65:667–77.
8.Berkes MB., Little MT., Lazaro LE., Sculco PK., Cymerman RM., Daigl M, et al. Malleolar fractures and their ligamentous injury equivalents have similar outcomes in supination-external rotation type IV fractures of the ankle treated by anatomical internal fixation. J Bone Joint Surg Br. 2012. 94:1567–72.
9.Wilson FC Jr., Skilbred LA. Long-term results in the treatment of displaced bimalleolar fractures. J Bone Joint Surg Am. 1966. 48:1065–78.
10.Simanski CJ., Maegele MG., Lefering R., Lehnen DM., Kawel N., Riess P, et al. Functional treatment and early weightbearing after an ankle fracture: a prospective study. J Orthop Trauma. 2006. 20:108–14.
11.Lehtonen H., Järvinen TL., Honkonen S., Nyman M., Vihtonen K., Järvinen M. Use of a cast compared with a functional ankle brace after operative treatment of an ankle fracture. A prospective, randomized study. J Bone Joint Surg Am. 2003. 85:205–11.
12.Finsen V., Saetermo R., Kibsgaard L., Farran K., Engebretsen L., Bolz KD, et al. Early postoperative weight-bearing and muscle activity in patients who have a fracture of the ankle. J Bone Joint Surg Am. 1989. 71:23–7.
13.Burr DB., Frederickson RG., Pavlinch C., Sickles M., Burkart S. Intracast muscle stimulation prevents bone and cartilage deterioration in cast-immobilized rabbits. Clin Orthop Relat Res. 1984. 189:264–78.
14.Salter RB., Hamilton HW., Wedge JH., Tile M., Torode IP., O’Driscoll SW, et al. Clinical application of basic research on continuous passive motion for disorders and injuries of synovial joints: a preliminary report of a feasibility study. J Orthop Res. 1984. 1:325–42.
15.Ahl T., Dalén N., Selvik G. Mobilization after operation of ankle fractures. Good results of early motion and weight bearing. Acta Orthop Scand. 1988. 59:302–6.
16.Egol KA., Dolan R., Koval KJ. Functional outcome of surgery for fractures of the ankle. A prospective, randomised comparison of management in a cast or a functional brace. J Bone Joint Surg Br. 2000. 82:246–9.