University Hospitals of Leicester NHS Trust, Leicester, UK.
Foot Ankle Int. 2021 Sep;42(9):1162-1170. doi: 10.1177/10711007211003073. Epub 2021 Apr 26.
Several studies have reported on potential negative predictive factors of functional outcomes after ankle fracture fixation. However, there is minimal patient-reported data on long-term outcomes. This study aimed to evaluate potential risk factors leading to a poor patient-reported functional outcome at 2 and 5 years following ankle fracture fixation.
We conducted a prospective cohort study over a 5-year period on patients undergoing open reduction and internal fixation for unstable ankle fractures. Patient demographics, medical comorbidities, fracture pattern, and fixation quality were recorded and analyzed. Patients were followed up at 2 and 5 years. Data collected include the Olerud-Molander Ankle Score (OMAS), Lower Extremity Functional Scale (LEFS), ongoing issues, and the need for further intervention. A value <.05 was considered statistically significant.
Out of 180 patients, follow-up data were available for 82 (46%) patients at 2 years and 94 (52%) patients at 5 years. At 2 years, age ≥60 years was a predictor of worse LEFS, while a body mass index ≥30 was a predictor of worse OMAS. Severely deformed ankle at presentation showed worse OMAS and LEFS score. However, these predictive factors were not significant at 5 years. An anatomically reduced ankle fracture fixation was more likely to have a better functional outcome at the 2- and 5-year follow-ups. A reduction in OMAS at 2 years was predictive of possible ongoing issues following surgery, which in turn increased the odds of worsening OMAS at 5 years.
Achieving adequate fracture reduction during fixation is crucial for better ankle functional recovery postinjury. In this cohort, we found that patients who undergo ankle fracture fixation will have an ongoing negative impact on their functional and physical capacity at both 2 and 5 years postoperatively. Appropriate patient counseling is necessary to prepare them for the expected functional outcomes.
Level II, prognostic.
多项研究报道了踝关节骨折固定后功能结果的潜在负性预测因素。然而，关于长期结果的患者报告数据很少。本研究旨在评估导致踝关节骨折固定后 2 年和 5 年患者报告功能结果不良的潜在风险因素。
我们进行了一项为期 5 年的前瞻性队列研究，纳入接受切开复位内固定术治疗不稳定踝关节骨折的患者。记录并分析患者的人口统计学、合并症、骨折模式和固定质量。患者在 2 年和 5 年时进行随访。收集的数据包括 Olerud-Molander 踝关节评分（OMAS）、下肢功能量表（LEFS）、持续存在的问题以及是否需要进一步干预。 值<0.05 被认为具有统计学意义。
在 180 例患者中，82 例（46%）患者在 2 年时和 94 例（52%）患者在 5 年时获得了随访数据。在 2 年时，年龄≥60 岁是 LEFS 更差的预测因素，而 BMI≥30 是 OMAS 更差的预测因素。就诊时踝关节严重畸形显示 OMAS 和 LEFS 评分更差。然而，这些预测因素在 5 年时并不显著。解剖复位的踝关节骨折固定术在 2 年和 5 年随访时更有可能获得更好的功能结果。2 年时 OMAS 的降低预测术后可能存在持续问题，进而增加 5 年时 OMAS 恶化的可能性。
在固定过程中实现足够的骨折复位对于受伤后更好的踝关节功能恢复至关重要。在本队列中，我们发现接受踝关节骨折固定术的患者在术后 2 年和 5 年均会对其功能和身体能力产生持续的负面影响。需要对患者进行适当的咨询，使他们为预期的功能结果做好准备。
Ⅱ级，预后。
