title: Risk factors for post-traumatic osteoarthritis of the ankle: an eighteen year follow-up study.
abstract: OBJECTIVE
  Long-term studies evaluating risk factors for development of ankle osteoarthritis (OA) following malleolar fractures are sparse.
  
  
  METHODS
  We conducted a retrospective cohort study including consecutive patients treated by open reduction and internal fixation for malleolar fracture between January 1988 and December 1997. Perioperative information was obtained retrospectively. Patients were evaluated clinically and radiographically 12-22 years postoperatively. Radiographic ankle OA was determined on standardised radiographs using the Kellgren and Lawrence scale (grade 3-4=advanced OA). Uni- and multivariate regression analyses were performed to determine risk factors for OA.
  
  
  RESULTS
  During the inclusion period, 373 fractures (372 patients; 9% Weber A, 58% Weber B, 33% Weber C) were operated upon. The mean age at operation was 42.9 years. There were 102 patients seen at follow-up (mean follow-up 17.9 years). Those not available did not differ in demographics and fracture type from those seen. Advanced radiographic OA was present in 37 patients (36.3%). Significant risk factors were: Weber C fracture, associated medial malleolar fracture, fracture-dislocation, increasing body mass index, age 30 years or more and length of time since surgery.
  
  
  CONCLUSIONS
  Advanced radiographic OA was common 12-22 years after malleolar fracture. The probability of developing post-traumatic OA among patients having three or more risk factors was 60-70%.
authors.affiliation: Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, 4, rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland. anne.lubbekewolff@hcuge.ch
authors.forename: Anne
authors.initials: A
authors.lastname: Lübbeke
authors.forename: Davide
authors.initials: D
authors.lastname: Salvo
authors.forename: Richard
authors.initials: R
authors.lastname: Stern
authors.forename: Pierre
authors.initials: P
authors.lastname: Hoffmeyer
authors.forename: Nicolas
authors.initials: N
authors.lastname: Holzer
authors.forename: Mathieu
authors.initials: M
authors.lastname: Assal
mesh_terms: D000328:Adult; D000367:Age Factors; D016512:Ankle Injuries / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D000843:Ankle Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D015992:Body Mass Index; D004651:Employment; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000009:adverse effects*; D050723:Fractures, Bone / Q000145:classification / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology*; D011183:Postoperative Complications; D011859:Radiography; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors