Summary

We verified that there was a positive clinical evolution in the follow-up of these patients. Those with the worst clinical and functional results had a complete rupture of both deltoid ligament bundles and syndesmosis associated lesion.

Abstract

Malleolar fractures represent about 10.2% of all fractures.
Recent epidemiologic studies calculated an incidence of 168.7/100.000/year, being the lateral malleolus 55% of all ankle fractures.
The purpose of this study was to evaluate the predictive factures of functional recovery after malleolar fracture. This knowledge is essential because it will enable a precise prognosis of the possible functional recovery and with the aim of a specific rehabilitation. Besides being an actual and relevant theme, in the literature there are few studies about it.
For this effect the authors proposed a prospective longitudinal observational study. The indicators of the project are based on a population of 205 patients with malleolar fracture.
The eligibility of the participant was guaranteed by the accomplishment of the inclusion and exclusion criteria.
The clinical evaluation of the ankle, as well as the quality of life was realized according to the functional AOFAS scale, the visual analogue scale – VAS and the questionnaire EQ-5D (ID L-29195). Our patients were evaluated by the time of the trauma, 6 months and 18 months follow-up. The studied variables are age, gender, type of trauma, trauma mechanism, laterality, AO classification, ASA (American Society of Anaesthesiologists), diabetes, smoking and obesity using a multiple linear regression multivariate analysis with version 23 of Statistical Package for the Social Sciences (SPSS).
Of the 146 eligible patients, 53 (36,3%) were male and 93 (63,7%) female. The mean age was 54.4 ± 19.1. We classified the malleolar fracture by the AO classification in type A, 31 patients (21.2%), type B in 100 patients (68,5%) and type C in 15 patients (10,3%). By the AOFAS scale we obtained increasingly higher mean values of 18.9, 89.5 and 93.6; by the VAS a progressive decrease of 74.5, 19.1 and 15.4; by the EQ-5D a progressive improvement of the quality of life 0.013, 0.679 and 0.772, respectively.
Only 2 patients had an unfavorable result, corresponding to fractures classified as 44B3.3 and 44C1.3 (p > 0,05).
Our patients (98,6%) had a progressive functional recovery with an evident improvement in their quality of life. It is important to underline the fact an age superior to 50 years, ASA III/IV and an instability due to a deltoid ligament rupture constitute negative predictive factors of that functional recovery.
The identification of patients in risk will allow to adopt rehabilitation plan more adequate to each one of the patients with malleolar fractures and maximize the therapeutic clinical efficiency. This will enable an anticipated return to their previous life activity levels.
We verified that there was a positive clinical evolution in the follow-up of these patients. Those with the worst clinical and functional results had a complete rupture of both deltoid ligament bundles and syndesmosis associated lesion.