Journal List > J Korean Foot Ankle Soc > v.21(1) > 1043437

Song, Lee, Seo, and Ryu: Clinical Outcome after Early Rehabilitation according to Injury Type in Ankle Fracture

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.

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Table 1.
Outcomes according to Fracture Type
Fracture type No. of patients Residual pain, n (%) Loss of motion, n (%) Olerud-Molander score
LM Fx only 10 1 (10.0) 0 78.59
MM Fx only 4 0 0 80.00
LM+MM Fx 20 3 (15.0) 5 (25.0) 73.63
LM+PM Fx 7 0 0 77.24
MM+PM Fx 1 0 0 78.19
TM Fx 40 3 (7.5) 8 (20.0) 73.08
Total 82 7 13

LM: lateral malleolus, Fx: fracture, MM: medial malleolus, PM: posterior malleolus, TM: trimalleolar fracture.

Table 2.
Outcomes according to Fracture with Ligament Injury
Fracture type No. of patients Residual pain, n (%) Loss of motion, n (%) Olerud-Molander score
LM Fx+Synd 2 0 0 73.93
LM Fx+deltoid 14 1 (7.1) 1 (7.1) 77.14
LM Fx+Synd+deltoid 10 3 (30.0) 3 (30.0) 73.80
PM Fx+Synd+deltoid 1 0 1 (100) 74.01
Maisoneuve Fx 2 0 0 78.54
LM Fx+MM Fx+Synd 7 0 0 79.12
LM Fx+PM Fx+Synd+deltoid 7 2 (28.6) 2 (28.6) 73.15
MM Fx+PM Fx+Synd 1 0 0 77.10
TM Fx+Synd 10 4 (40.0) 3 (30.0) 74.50
Total 54 10 10

LM: lateral malleolus, Fx: fracture, Synd: syndesmosis, PM: posterior malleolus, MM: medial malleolus, TM: trimalleolar fracture.

Table 3.
Outcomes according to Lauge Hansen Classification
Fracture type No. of patients Residual pain, n (%) Loss of motion, n (%) Olerud-Molander score
SER 78 9 (11.5) 16 (20.5) 74.71
PER 29 6 (20.7) 5 (17.2) 72.85
PAB SAD 15 14 2 (13.3) 0 1 (6.7) 1 (7.1) 76.50 76.00
Total 136 17 (12.5) 23 (16.9)

SER: supination-external rotation, PER: pronation-external rotation, PAB: pronation-abduction, SAD: supination-adduction.

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