title: Occupational Outcomes and Return to Running Following Internal Fixation of Ankle Fractures in a High-Demand Population.
abstract: BACKGROUND
  Literature evaluating surgical outcomes after ankle fixation in an active patient population is limited. This study determined occupational outcomes and return to running following ankle fracture fixation in a military cohort.
  
  
  METHODS
  All service members undergoing ankle fracture fixation at a single military hospital from August 2007 to August 2012 were reviewed. Univariate analysis determined the association between patient demographic information, type of fracture fixation, and the development of posttraumatic ankle arthritis and functional outcomes, including medical separation, return to running, and reoperation. Seventy-two primary ankle fracture fixation procedures were performed on patients with mean age of 29.1 years. The majority of patients were male (88%), were 25 years of age or older (61%), were of junior rank (57%), underwent unimalleolar fracture fixation (78%), and did not require syndesmotic fixation (54%). The average follow-up was 35.9 months.
  
  
  RESULTS
  The mean time to radiographic union was 8.6 weeks. Twelve service members (17%) were medically separated from the military due to refractory pain following ankle fracture fixation with a minimum of 2-year occupational follow-up. Among military service members undergoing ankle fracture fixation, 64% returned to running. Service members with higher occupational demands had a statistical trend to return to running (odds ratio [OR] 2.49; 95% CI, 0.93-6.68). Junior enlisted rank was a risk factor for medical separation (OR 11.00; 95% CI, 1.34-90.57). Radiographic evidence of posttraumatic ankle osteoarthritis occurred in 8 (11%) service members.
  
  
  CONCLUSIONS
  At mean 3-year follow-up, 83% of service members undergoing ankle fracture fixation remained on active duty or successfully completed their military service, while nearly two-thirds returned to occupationally required daily running.
  
  
  METHODS
  Level IV, retrospective case series.
authors: Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Texas Tech University Health Sciences Center, El Paso, TX, USA justin.d.orr.mil@mail.mil.
authors: Justin D
authors: JD
authors: Orr
authors: Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Texas Tech University Health Sciences Center, El Paso, TX, USA.
authors: Nicholas A
authors: NA
authors: Kusnezov
authors: Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Texas Tech University Health Sciences Center, El Paso, TX, USA.
authors: Brian R
authors: BR
authors: Waterman
authors: Statistical Consulting Laboratory, University of Texas at El Paso, El Paso, TX, USA.
authors: Julia O
authors: JO
authors: Bader
authors: Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Texas Tech University Health Sciences Center, El Paso, TX, USA.
authors: David M
authors: DM
authors: Romano
authors: Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Texas Tech University Health Sciences Center, El Paso, TX, USA.
authors: Philip J
authors: PJ
authors: Belmont
mesh_terms: D000328:Adult; D064386:Ankle Fractures / Q000503:physiopathology / Q000601:surgery*; D000843:Ankle Joint / Q000473:pathology; D005260:Female; D005593:Fracture Fixation, Internal; D006801:Humans; D008297:Male; D008889:Military Personnel; D009790:Occupations; D010003:Osteoarthritis / Q000473:pathology; D020127:Recovery of Function / Q000502:physiology; D012189:Retrospective Studies; D062707:Return to Work; D012420:Running / Q000502:physiology*; D055815:Young Adult
keywords: ankle fracture; fixation; military; occupation; outcome; running; surgery