title: Stability criteria for nonoperative ankle fracture management.
abstract: BACKGROUND
  This study was designed to see if stability based criteria are useful in choosing between nonoperative and operative treatment of ankle fractures.
  
  
  METHODS
  One hundred sixty ankle fractures in skeletally mature patients were retrospectively analyzed to obtain an epidemiological profile in a population of about 130,000. One hundred thirty patients had followup of more than 2 years. A decision between operative and nonoperative treatment was made by the surgeon-on-duty, based on accepted stability criteria. Fractures were classified according to Weber and Lauge-Hansen systems. Clinical outcome was assessed using the scoring systems of Olerud-Molander, the RAND 36-Item Health Survey and the Visual Analogue Scale (VAS), measuring pain and function.
  
  
  RESULTS
  The overall incidence of ankle fractures was 154/100,000. Nonoperatively treated patients had more displacement of the distal fibula after treatment, but less pain and better Olerud-Molander (good or excellent, 89% vs. 71%) and VAS functional scores. Independent factors for worse outcome were female gender, older age, unstable fracture and co-morbidity. No nonoperatively treated patients needed operative fixation during followup.
  
  
  CONCLUSIONS
  Stability-based fracture classification was a simple and useful tool in decision-making for the treatment of ankle fractures. We found lateral malleolar fractures could be treated nonoperatively with success if the ankle mortise was stable. Displacement of the distal fibula after treatment did not affect functional scores or pain.
authors.affiliation: Department of Surgery, Division Orthopedic and Trauma Surgery, Oulu University Hospital, FI 90029 OYS, Oulu, Finland. harri.pakarinen@ppshp.fi
authors.forename: Harri J
authors.initials: HJ
authors.lastname: Pakarinen
authors.forename: Tapio E
authors.initials: TE
authors.lastname: Flinkkil
authors.forename: Pasi P
authors.initials: PP
authors.lastname: Ohtonen
authors.forename: Jukka Y
authors.initials: JY
authors.lastname: Ristiniemi
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016512:Ankle Injuries / Q000628:therapy*; D015897:Comorbidity; D003657:Decision Making; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000145:classification / Q000628:therapy*; D006801:Humans; D015994:Incidence; D007593:Joint Instability / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D012189:Retrospective Studies; D012737:Sex Factors