title: Outcomes Over a Decade After Surgery for Unstable Ankle Fracture: Functional Recovery Seen 1 Year Postoperatively Does Not Decay With Time.
abstract: OBJECTIVE
  To evaluate long-term clinical and radiographic outcomes after surgical fixation of unstable ankle fractures.
  
  
  METHODS
  Prospective follow-up study.
  
  
  METHODS
  Academic medical center with 2 Level-I trauma centers and a tertiary care center.
  
  
  METHODS
  One hundred forty-one patients who underwent surgical repair of an unstable ankle fracture.
  
  
  METHODS
  Open reduction internal fixation of an unstable ankle fracture.
  
  
  METHODS
  Short Musculoskeletal Function Assessment (SMFA) scores and radiographic outcomes based on the van Dijk criteria at a mean of 11.6 years follow-up.
  
  
  RESULTS
  Of the 281 patients meeting the inclusion criteria for this study, follow-up data were obtained from 141 patients (50%), at a mean of 11.6 years after surgery. Overall, mean long-term SMFA scores were improved when compared with scores at 1 year. The American Society of Anesthesiologists class 1 or 2 was found to be a significant predictor of recovery based on SMFA scores. Sixty-three percent of follow-up radiographs demonstrated evidence of radiographic arthritis, including 31% with mild osteoarthritis, 22% with moderate osteoarthritis, and 10% with severe osteoarthritis. Fracture dislocation at injury was found to be a significant predictor of radiographic posttraumatic osteoarthritis at latest follow-up. One patient (0.7%) underwent a tibiotalar fusion secondary to symptomatic posttraumatic arthrosis. One patient (0.7%) underwent total ankle replacement due to severe osteoarthritis.
  
  
  CONCLUSIONS
  Our data indicate that over a decade after ankle fracture fixation, most of the patients are doing well. Despite the presence of radiographic arthritis in 63% of patients, few experience pain or have restrictions in function, and mean long-term functional outcome scores are improved when compared with scores at 1 year. Patients undergoing operative fixation of unstable ankle fractures can anticipate functional outcomes that are maintained over time.
  
  
  METHODS
  Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: *Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, NY; †UAB Department of Orthopaedic Surgery, UAB Orthopaedic Clinic, Birmingham, AL; and ‡Department of Orthopaedic Surgery, Jamaica Hospital Medical Center, Jamaica, NY.
authors.forename: Deirdre K
authors.initials: DK
authors.lastname: Regan
authors.forename: Stephen
authors.initials: S
authors.lastname: Gould
authors.forename: Arthur
authors.initials: A
authors.lastname: Manoli
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Egol
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D064386:Ankle Fractures / Q000175:diagnosis / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods*; D017102:Fracture Healing / Q000502:physiology*; D006801:Humans; D015601:Injury Severity Score; D007593:Joint Instability / Q000175:diagnosis / Q000601:surgery*; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D015999:Multivariate Analysis; D010147:Pain Measurement; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011446:Prospective Studies; D011859:Radiography / Q000379:methods; D018570:Risk Assessment; D013997:Time Factors; D014193:Trauma Centers