Aims
This study aimed to identify the risk factors for posttraumatic osteoarthritis (OA) after surgery with ankle fractures in young and middle-aged patients. Furthermore, the rate of posttraumatic OA and clinical outcomes were evaluated.
Patients and Methods
We performed a retrospective review between 2005 and 2014 of consecutive patients who underwent operation with ankle fractures and available at minimum 5 years of follow up. Patients aged over 50 years were excluded to minimize the selection bias related to primary ankle OA. Patients were sorted into 2 groups according to the presence of OA more than Kellgren-Lawrence classification grade 3 at last follow up. Statistical binary logistic regression analyses were performed including age at surgery, sex, diabetes, smoking, body mass index (BMI), AO/OTA classification, associated fracture of the posterior malleolus (PM), joint congruency, associated deltoid ligament injury, and syndesmosis injury. The functional outcomes were assessed with the Foot and Ankle Outcome Score.
Results
In total, 332 patients who met the study inclusion criteria underwent analysis. The overall rate of posttraumatic arthritic change was 27.7% (non-arthritis group: 240 patients, arthritis group: 92). It was significantly affected by the BMI (p=0.011; adjusted odds ratio (OR) = 30, 6.56), fracture dislocation injury (p=0.024, adjusted OR 4.06), PM fracture (p=0.031, adjusted OR >25% of articular surface, 5.72), and postoperative articular incongruence (p=0.034, adjusted OR 7.21). The mean scores in the group with arthritis were significantly lower than those in the group without arthritis (p<0.05)
Conclusion
Obesity, fracture dislocation injury, concomitant large PM fracture and its malreduction were significant risk factors for postoperative OA after surgery with ankle fractures. Surgeons should be aware that accurate reduction should be considered in ankle fracture patient with large PM fracture, especially when patients were obese or severe initial injury such as fracture dislocation.