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Study identifies risk factors in the development of OA after malleolar fracture

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SAN DIEGO — Increased BMI and age are among risk factors for advanced ankle osteoarthritis 12 years to 22 years after a malleolar fracture, according to a study presented here.

Anne Lubbeke-Wolff

Anne Lubbeke-Wolff, MD, DSc, presented her group’s findings at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons.

Weber C fractures, medial malleolus fractures and fracture dislocation all increase the risk as well.

“Age was associated with a substantially higher risk of osteoarthritis, in addition to increasing BMI [body mass index],” Lubbeke-Wolff said.

A retrospective study

Lubbeke-Wolff and her group performed a retrospective cohort study, analyzing results from consecutive patients at her institution who were treated with open reduction and internal fixation (ORIF) for malleolar fractures between Jan. 1988 and Dec. 1997.

Standardized radiographs were used by two independent reviewers to assess ankle osteoarthritis (OA), and a multivariate logistic regression analysis was performed to determine predictors for OA.

In all, 374 patients underwent surgery during the study period. Nine percent of these patients had a Weber A fracture, with 58% sustaining a Weber B fracture and 33% sustaining a Weber C fracture.

Risk factors make a difference

Lubbeke-Wolff reported that 12 to 22 years after surgery, 47 patients had died, 126 were lost to follow-up and 99 refused to participate or did not respond — leaving 102 patients. These patients were similar in age, gender, BMI and type of fracture to those patients who were not seen.

The group reported advanced OA in 37 patients (36.3%). Significant risk factors for advanced OA were identified as fracture type, presence of medial malleolus fracture, fracture dislocation, increasing BMI, older age and longer follow-up time.

“Advanced radiologic osteoarthritis was present in 36% of the patients who underwent treatment for malleolar fractures,” Lubbeke-Wolff said, adding that this was – to her knowledge – the first study to quantify the risks factors inherent to the problem of OA following this type of fracture. “The risk of [OA] in patients with only one or two factors was small, but it was substantially higher in patients with three or more factors.”

Reference:

• Lubbeke-Wolff A, et al. Risk factors for post-traumatic ankle osteoarthritis: A 12-22 year follow-up study. Paper 091. Presented at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons. Feb. 15-19, 2011. San Diego.

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