A prospective analysis of reduction and internal fixation of closed ankle fractures
Marthand Kulkarni, Rahul Rajkumar Agrawal, Abrar Mohammed
Background: Ankle fractures are a very common type of fractures encountered by orthopaedicians. There has been an increased prevalence of such fractures over the last two decades both in young, active patients and in the elderly1,2. Increase in the road traffic accidents, sports injury, fall from heights, industrial accidents etc are the cause for increased incidence of these fractures. The ankle injuries have potential to produce significant long-term disability and complications3. The goal of treatment of these fractures is both a healed fracture and an ankle that moves and functions normally without pain. This can be achieved by anatomical reduction which includes restoration of normal tibio-fibular relationship, restoration of articular congruence, restoration of length, rotation and obliquity of distal fibula. Materials and Methods: The study is a clinical prospective and observational study conducted at KBNTGH, Kalaburagi The material comprises of 30 adults patients of either sex with closed displaced ankle fracture treated with open reduction and internal fixation using different surgical procedure and implants in the department of Orthopaedics, KBNTGH, Kalaburagi during the period of July 2017 to June 2019.Results: 30 patients with unstable fracture of ankle joint treated with open reduction and internal fixation Age of the patients ranged from 21 to 72 years. Majority of the patients were males. The mode of injury in maximum patients was road traffic accidents. Bimalleolar fracture was most common type observed in 18 patients. According to Lauge-Hansen classification Supination external rotation injury was most common type seen in 12 patients. All patients were operatively treated immediately after swelling subsided using appropriate implant for fracture pattern. Average rate of clinical union was observed between 16-18 weeks. The rate of radiological union in majority of patients was around 18-20 weeks.Most patients were given well padded below knee slab in full dorsiflexion for six weeks. During this period partial weight bearing was allowed using crutches. After six weeks progressive unrestricted weight bearing and range of motion exercises were started and patients were reviewed every month till union.There was 1 case of non-union.3 cases developed superficial to deep infection which responded well to antibiotics. Most of the patients were discharged on post-operative day 14 after suture removal.Functional outcome was satisfactory as 90% patients had excellent to fair outcome.Conclusion: The conclusion of our study is:
Ankle injuries commonly result from road traffic accidents and twisting injuries.
Young, active and mobile patients are at greater risk for sustaining ankle injuries.
A good reduction and fixation requires a thorough knowledge of mechanism of injury of ankle.
Displaced and unstable ankle injuries often require early operative treatment for early and better functional outcome.
The choice of implant is crucial to neutralize the deforming forces to obtain optimal results.
Early intervention, good aseptic precautions and good general condition of patient will reduce the chances of infection.
Good results can be expected even if the time for union is longer.
Hence we conclude that a pre-operatively well defined fracture pattern in each patient aids in implant and technique selection for optimal reduction and fixation which in turn leads to early restoration of patient to his routine activities.
Marthand Kulkarni, Rahul Rajkumar Agrawal, Abrar Mohammed. A prospective analysis of reduction and internal fixation of closed ankle fractures. International Journal of Medical and Health Research, Volume 7, Issue 3, 2021, Pages 70-76