Findings from a cohort study point to factors that may influence the outcome of patients with ankle fractures requiring surgery.
The research included 41 women and 19 men, aged an average of 49 years, with an ankle fracture treated with open reduction with internal fixation between 2007 and 2009. The patients were followed up for nonunion or malunion, and for healing complications.
As reported in the Journal of Foot and Ankle Surgery, analysis showed that patients with trimalleolar fractures took a significant 22 days less to show radiographic healing than patients with bimalleolar or other fracture types.
Patients with dislocation had a significantly longer period of immobilization than those who did not, as did patients who smoked cigarettes compared with nonsmokers.
The time to return to everyday activities was significantly influenced by fracture type but no other factors. Patients with trimalleolar fractures took a significant 34.3 days longer to return to everyday activities than patients with bimalleolar fractures.
Further analysis showed that diabetic neuropathy was associated with a 7.63-fold increased risk for wound complications compared with no neuropathy, and trimalleolar fracture was associated with a 14.3-fold increased risk for complications compared with bimalleolar fracture.
However, the likelihood of wound complications was not influenced by age, smoking, or dislocation.
"We believe that the results of our investigation can be used in the development of future randomized controlled trials and prospective cohort studies," write Robert Mendicino (Western Pennsylvania Hospital, Pittsburgh, USA) and co-authors.
They conclude: "The goal of our study was to provide a comprehensive analysis of the factors affecting the healing after ankle fracture surgery and how this affects the clinical course. To our knowledge, no studies exist that have investigated such a diverse variety of clinical outcomes."
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