Abstract :

Background: Non-operative management is a common approach for treating closed ankle fractures at Mulago National Referral Hospital (MNRH) due to its potential benefits, including shorter hospital stays and the absence of surgical risks. Evaluating functional and radiological outcomes is essential for determining the success of this treatment. This study aimed to evaluate the functional and radiological outcomes of ankle fractures managed non-operatively and to identify the factors associated with these outcomes.

Methods: This cross-sectional study assessed 93 adults with ankle fractures managed non-operatively at six months post-injury at Mulago National Referral Hospital. Functional outcomes were evaluated using the AOFAS ankle-hindfoot score, while radiological outcomes included fracture union and ankle alignment parameters. Data were analyzed using STATA, and modified Poisson regression was applied to identify factors associated with functional and radiological outcomes.

Results: The mean age and standard deviation were 41+/-12 years. More females, n=49(52.7%), had ankle fractures. The commonest fracture type was Weber B n=65(69.9%)> Weber C n=16(17.2%)> Weber A n=12 (12.9%). The mean AOFAS-AH score was 82.9 ± 14.9. Patients had an AOFAS-AH score categorized as good (54.8%)>excellent (23.7%)>fair (16.1%)>poor (5.4%). Eight-six (92.5%) had radiological union, and 7(7.5%) had nonunion. 97.7% of the patients had a normal MCS, 80.2% normal TFO, 50% normal TCA, and 13.9% normal TFCS. Significant predictors of poor functional outcomes included being HIV-positive, Weber B fractures, and Weber C fractures. Predictors of good functional outcomes included receiving physiotherapy and initiating weight bearing at 4-6 weeks or after 6 weeks

Conclusion: The majority of participants achieved radiological union, though all united fractures resulted in malunion. Worse functional outcomes were associated with Weber classifications B and C, as well as HIV-positive status.

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Keywords :

Ankle fracture, functional outcome, radiological outcome, Weber fracture classification

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References :

1. Tunturi T, Kemppainen K, Pätiälä H, Suokas M, Tamminen O, Rokkanen P. Importance of anatomical reduction for subjective recovery after ankle fracture. Acta Orthop. 1983;54(4):641–7.
2. Mcphail SM, Dunstan J, Canning J, Haines Life impact of ankle fractures: Qualitative analysis of patient and clinician experiences. 2012 [cited 2023 Jul 27]; Available from: http://www.biomedcentral.com/1471-2474/13/224
3. Van Schie-Van Der Weert EM, Van Lieshout E M M, De Vries • M R, Van Der Elst • M, Schepers • T. Determinants of outcome in operatively and non-operatively treated Weber-B ankle fractures.
4. Alhammoud A, Khamis KM, Mekhaimar MM. Surgical versus non surgical management of Geriatrics ankle fractures. A Systematic Review and Meta-analysis. 2018 [cited 2023 Aug 15]; Available from: http://www.sagepub.com/journalsPermissions.nav.

5. Kurar L. Clinical audit of ankle fracture management in the elderly *. 2016 [cited 2023 Aug 21]; Available from: http://dx.doi.org/10.1016/j.amsu.2015.12.061
6. Javed OA, Javed QA, Ukoumunne O, Mascio L Di, Javed OA. ORE Open Research Exeter TITLE Surgical versus conservative management of ankle fractures in adults: A systematic review and meta-analysis A NOTE ON VERSIONS Surgical versus conservative management of ankle fractures in adults: a systematic review and meta-analysis. 2020 [cited 2023 Nov 16]; Available from: http://hdl.handle.net/10871/40219
7. Juto H, Nilsson H, Morberg Epidemiology of Adult Ankle Fractures: 1756 cases identified in Norrbotten County during 2009-2013 and classified according to AO/OTA. BMC Musculoskelet Disord. 2018 Dec 13;19(1).
8. Shakir A, Zahid T, Qayyum N, Kashmiri N, Ahmed Shakir I. Pattern of Bimalleolar Ankle Fractures [Internet]. Vol. 21, Journal of Rawalpindi Medical College (JRMC. 2017. Available from: https://www.researchgate.net/publication/335927456

9. Samuel Edward Davies P, Pennington R, Singh Dhadwal A, Chokotho L, Nyamulani N, Mpanga C, et Clinical outcomes of ankle fractures in sub-Saharan Africa: a systematic review. European Journal of Orthopaedic Surgery & Traumatology [Internet]. 2023;33(3):547–57. Available from: https://doi.org/10.1007/s00590-022-03397-7
10. Herrera-Pérez M, González-Martín D, Vallejo-Márquez M, Godoy-Santos AL, Valderrabano V, Tejero S. Clinical Medicine Ankle Osteoarthritis Aetiology. J Clin Med [Internet]. 2021;10:4489. Available from: https://doi.org/10.3390/jcm10194489

11. Libois A, Clumeck N, Kabeya K, Gerard M, De Wit S, Poll B, et al. Risk factors of osteopenia in HIV-infected women: No role of antiretroviral therapy. Maturitas. 2010 Jan;65(1):51–4.
12. S. Kamat, M. Govender. THE EFFECTS OF HIV/AIDS ON FRACTURE UNION. orthopaedic proceedings . 2010 Mar 1;92-BNo.SUPP_1(1):228–228.
13. Moseley AM, Beckenkamp PR, Haas M, Herbert RD, Lin CWC, Evans P, et al. Rehabilitation after immobilization for ankle fracture: The EXACT randomized clinical trial. JAMA – Journal of the American Medical Association. 2015 Oct 6;314(13):1376–85.
14. Painter EE, Deyle GD, Allen C, Petersen EJ, Croy T, Rivera KP. Manual physical therapy following immobilization for stable ankle fracture: A case series. Journal of Orthopaedic and Sports Physical Therapy. 2015 Sep 1;45(9):665–74.