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Long-term outcome of pronation-external rotation ankle fractures treated with syndesmotic screws only.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Lambers, Kaj T. A. Van Den Bekerom, Michel P. J. Doornberg, Job N. Stufkens, Sjoerd A. S. Van Dijk, C. Niek Kloen, Peter
Description	Country affiliation: Netherlands Author Affiliation: Lambers KT ( Department of Orthopaedic Surgery, Academic Medical Center Amsterdam, Meibergdreef 9, 1100 DD Amsterdam, The Netherlands. ktalambers@gmail.com)
Abstract	BACKGROUND: There is sparse information in the literature on the outcome of Maisonneuve-type pronation-external rotation ankle fractures treated with syndesmotic screws. The primary aim of this study was to determine the long-term results of such treatment of these fractures as indicated by standardized patient-based and physician-based outcome measures. The secondary aim was to identify predictors of the outcome with use of bivariate and multivariate statistical analysis. METHODS: Fifty patients with pronation-external rotation (predominantly Maisonneuve) fractures were treated with open reduction and internal fixation of the syndesmosis utilizing only one or two screws. The results were evaluated at a mean of twenty-one years after the fracture utilizing three standardized outcomes instruments: (1) the Foot and Ankle Ability Measure (FAAM), (2) the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale, and (3) the Center for Epidemiologic Studies-Depression (CES-D) Scale. Osteoarthritis was graded according to the van Dijk and revised Takakura radiographic scoring systems. Bivariate and multivariate analyses were performed to identify predictors of long-term outcome. RESULTS: Forty-four (92%) of forty-eighty patients had good or excellent AOFAS scores, and forty-four (90%) of forty-nine had good or excellent FAAM scores. Arthrodesis for severe osteoarthritis was performed in two patients. Radiographic evidence of osteoarthritis was observed in twenty-four (49%) of forty-nine patients. Multivariate analysis identified pain as the most important independent predictor of long-term ankle function as indicated by the AOFAS and FAAM scores, explaining 91% and 53% of the variation in scores, respectively. Analysis of pain as the dependent variable in bivariate analyses revealed that depression, ankle range of motion, and a subsequent surgery were significantly correlated with higher pain scores. No firm conclusions could be drawn after multivariate analysis of predictors of pain. CONCLUSIONS: Long-term functional outcomes at a mean of twenty-one years after pronation-external rotation ankle fractures treated with one or two syndesmotic screws were good to excellent in the great majority of patients despite substantial radiographic evidence of osteoarthritis in one-half of the patients. The most important predictor of long-term functional outcome was patient-reported pain rather than physician-reported function or posttraumatic osteoarthritis. There was no significant association between radiographic signs of posttraumatic osteoarthritis and perceived pain in the present series.
File Format	HTM / HTML
ISSN	00219355
Issue Number	17
Volume Number	95
e-ISSN	15351386
Journal	The Journal of Bone and Joint Surgery-American Volume
Language	English
Publisher	Lippincott Williams & Wilkins
Publisher Date	2013-09-04
Publisher Place	United States
Access Restriction	Subscribed
Subject Keyword	Discipline Orthopedic surgery Ankle Injuries Surgery Ankle Joint Ankle Fractures, Bone Range Of Motion, Articular Physiology Adolescent Adult Physiopathology Bone Screws Female Fracture Fixation, Internal Humans Male Middle Aged Pronation Radiography Recovery Of Function Rotation Treatment Outcome Journal Article
Content Type	Text
Resource Type	Article
Subject Domain (in MeSH)	Body Regions Musculoskeletal System Eukaryota Wounds and Injuries Diagnosis Surgical Procedures, Operative Equipment and Supplies Physical Phenomena Musculoskeletal and Neural Physiological Phenomena Biological Phenomena Persons
Subject	Sports Science Surgery Orthopedics and Sports Medicine

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