SLR - August 2023 - Thomas Milisits, DPM, MPH
Title: Risk Factors Associated With Worse Clinical Outcomes of Ankle Fractures Involving the Posterior MalleolusReference: Rajan L, Eble S, Kim J, Kukadia S, Kumar P, Day J, Cho D, Drakos M, Ellis S. Risk Factors Associated With Worse Clinical Outcomes of Ankle Fractures Involving the Posterior Malleolus. Foot Ankle Orthop. 2023 Feb 23;8(1)
Reviewed By: Thomas Milisits, DPM, MPH
Residency Program: MedStar Washington Hospital Center/MedStar Georgetown University
Podiatric Relevance: A common pathology treated by podiatric surgeons are ankle fractures. Recent literature has debated the specifics of treatment for these fractures, particularly when it comes to the posterior malleolus. It is generally accepted that patients with posterior malleolus involvement tend to have worse outcomes whether it is fixed or not. However, there has not been much research on optimal surgical management or risk factors leading to poor outcomes. This study analyzes 122 patients either with fixation of the posterior malleolus or treated nonoperatively to assess risk factors associated with poor outcomes in fractures involving the posterior malleolus.
Methods: A level III retrospective cohort study was performed for all patients who sustained a rotational ankle fracture involving the posterior malleolus. A total of 122 patients were included, where 72 (59%) had operative fixation of the posterior malleolus, and 50 (41%) were treated nonoperatively. Patient-reported functional outcomes were collected prospectively by using PROMIS surveys and T-scores were recorded for Physical Function, Pain Interference, Pain Intensity, Global Physical Health, Global Mental Health, and Depression.
Results: Elevated BMI and trimalleolar fractures were found to be significantly associated with lower postoperative PROMIS scores. Fracture morphology, fracture mechanism, articular involvement, and operative fixation were not significantly associated with lower postoperative PROMIS scores. There were no cases of infection or delayed wound healing. Forty-one patients underwent removal or hardware.
Conclusions: This study gives important insight into certain risk factors such as mechanism and morphology of trimalleolar ankle fractures which can help surgeons carefully decide between surgical and nonsurgical intervention. Higher BMI is often associated with other comorbidities so carefully assessing these risk factors prior to deciding a treatment plan may help in patient outcomes.