High incidence of osteochondral lesions after open reduction and internal fixation of displaced ankle fractures: Medium-term follow-up of 100 cases |
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| Institution: | 1. Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany;2. Department of Trauma-, Hand-, and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany;3. Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany;1. Infectious Disease Pharmacokinetics Laboratory, College of Pharmacy, and Emerging Pathogens Institute, University of Florida, 1600 Southwest Archer Road, Gainesville, FL 32610-0486, USA;2. College of Medicine, and Emerging Pathogens Institute, University of Florida, 1600 Southwest Archer Road, Gainesville, FL 32610-0486, USA;1. Greenslopes Private Hospital, Brisbane, Australia;2. Queensland Unit for Advanced Shoulder Research (QUASR), Brisbane, Australia;3. Shoulder Surgery QLD Research Institute, Brisbane, Australia;1. Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School; Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114, USA;2. Chief of Hand Surgery, Massachusetts General Hospital, Harvard Medical School; Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114, USA;1. Servicio de Pediatría, Hospital Virgen de la Salud, Toledo, España;2. Instituto de Genética Médica y Molecular, Hospital La Paz, Madrid, España;3. Centro de Investigación Biomédica en Red en enfermedades raras (CIBERER);4. Unidad de Genética Clínica, Hospital La Fe, Valencia, España;5. Unidad de Genética Clínica, Hospital Vall d’Hebron, Barcelona, España;6. Servicio de Pediatría, Hospital Severo Ochoa, Leganés, Madrid, España;7. Unidad de Genética Médica, Servicio de Pediatría, Hospital Virgen de la Arrixaca, Cátedra de Genética Médica, Universidad Católica San Antonio de Murcia, Murcia, España;8. Unidad de Dismorfología, Servicio de Pediatría, Hospital Virgen del Rocío, Sevilla, España;9. Departamento de Genética Médica, Facultad de Medicina, Universidad de Tohoku, Sendai, Japón;10. Departamento de Genética, Facultad de Biología, Universidad de Barcelona, Instituto de Biomedicina de la Universitad de Barcelona (IBUB), Barcelona, España;11. Laboratorio Diagnóstico Molecular, Servicio de Bioquímica, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, España |
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| Abstract: | BackgroundThe incidence of osteochondral lesions (OCLs) in association with displaced ankle fractures has only been examined in two previous studies. In both studies magnetic resonance imaging (MRI) was performed prior to open reduction and internal fixation (ORIF). Because MRI may overdiagnose or overestimate the extent of OCLs in an acute trauma setting the aim of this study was to determine the incidence of OCLs after ORIF of displaced ankle fractures using MRI at medium-term follow-up, and to analyse if the severity of fracture or the clinical outcome correlates with the incidence of OCLs.Patients and methodsFollowing institutional review board approval a total of 100 patients (mean age, 41.3 years; range, 17.9–64.3 years) with a displaced ankle fracture who had undergone ORIF according to the AO principles were included in this study. The American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score was used to quantify the clinical outcome and MR images were evaluated for OCLs of the talus and distal tibia after a mean of 34.5 months (range, 17.5–54.1 months).ResultsOCLs were found in 40.4% of the patients. Logistic regression revealed a significant correlation between the severity of fracture and the incidence of OCLs. Patients with a trimalleolar fracture (p = 0.04) or an ankle fracture dislocation (p = 0.003) had a significantly higher risk for developing an OCL compared to those with a type B fracture. Logistic regression also demonstrated a significant correlation between the clinical outcome (AOFAS score) and the incidence of OCLs (p = 0.01). The risk for developing an OCL increases up to 5.6% when the AOFAS score decreases by one point.ConclusionOCLs were frequently found in association with acute ankle fractures at medium-term follow-up, and the severity of fracture was associated with an increased number of OCLs. Considering the disadvantages of MRI including the high cost and limited availability, the results of this study may help to explain why anatomic surgical realignment of displaced ankle fractures may still be associated with poor clinical outcomes. |
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| Keywords: | Osteochondral lesion Ankle fracture Talus Distal tibia |
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