title: A comprehensive analysis of patients with malreduced ankle fractures undergoing re-operation.
abstract: OBJECTIVE
  The present study aimed to determine the most common surgical errors resulting in early re-operation following ankle fracture surgery.
  
  
  METHODS
  We performed a chart review to determine the most common types of malreductions that led to early re-operation following ankle fracture surgery. From 2002 to 2011, we identified 5,123 consecutive ankle fracture operations in 5,071 patients. Seventy-nine patients (1.6%) which underwent re-operation due to malreduction detected in postoperative radiographs. These patients were compared with an equal number of age- and sex-matched controls which did not need further surgery.
  
  
  RESULTS
  The most common indication for re-operation was syndesmotic malreduction (47 of 79 patients, 59%). Four main types of errors related to syndesmotic reduction or fixation were identified, with the most common being fibular malpositioning within the tibiofibular incisura. Other indications for re-operation were fibular shortening and malreduction of the medial malleolus. Fracture dislocation, fracture type, posterior malleolar fracture, associated medial malleolar fracture, duration of index surgery, and fixation of an associated medial malleolar fracture with other than two parallel screws were also associated with re-operation. Correction of the malreduction was successfully achieved in the majority (84%) of cases needing further surgery.
  
  
  CONCLUSIONS
  Early re-operation after ankle fracture surgery was most commonly caused by errors related to syndesmotic reduction or failure to restore fibular length. In the majority of cases, postoperative malreduction was successfully corrected in the acute setting.
authors.affiliation: Department of Orthopaedics and Traumatology, Helsinki University Central Hospital, Topeliuksenkatu 5, 00260, Helsinki, Finland, mikko.ovaska@hus.fi.
authors.forename: Mikko T
authors.initials: MT
authors.lastname: Ovaska
authors.forename: Tatu J
authors.initials: TJ
authors.lastname: Mäkinen
authors.forename: Rami
authors.initials: R
authors.lastname: Madanat
authors.forename: Veikko
authors.initials: V
authors.lastname: Kiljunen
authors.forename: Jan
authors.initials: J
authors.lastname: Lindahl
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D064386:Ankle Fractures; D017760:Bone Malalignment / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects* / Q000379:methods; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult