Articular incongruency associated with poor results in patients with SER IV ankle fractures

CHICAGO — Surgically treated patients with supination external rotation type IV ankle fractures and articular incongruity showed worse clinical results than those without articular incongruity, according to research presented here.

“Articular incongruity was correlated with inferior short-term 1-year clinical outcomes in this group,” Milton T. Little, MD, said during his presentation. “This emphasizes the importance of articular reduction.”

Little and colleagues retrospectively reviewed the outcomes of 176 patients with supination external rotation type IV (SER IV) fractures. They considered ankles incongruent if they showed > 2 mm articular step-off, had a subchondral bone gap > 2 mm or had intra-articular loose bodies. Outcome measures included the Foot and Ankle Outcome Score (FAOS) and ankle range of motion (ROM). The average follow-up was 21 months.

Milton T. Little

The researchers found 67% of ankles were congruent and 33% showed articular incongruency. The groups had similar comorbidities, injury and treatment variables. The incongruent group showed statistically significantly worse FAOS scores compared with the congruent cohort. The FAOS symptom score was 66.8 in the incongruent group and 77.3 in the congruent group. The FAOS pain score was 72.1 in the incongruent group and 84.6 in the congruent group. The FAOS activities of daily living score was 78.9 for the incongruent group vs. 87.4 in the congruent group. The FAOS sports domain score was lower at 54.9 in the incongruent group compared to 65.8 in the congruent group. The investigators found comparable range of motion between the groups.

“This does suggest a role for advanced intraoperative imaging to help avoid malreduction and improve outcomes,” Little said.

Reference:

Little M. Paper #19. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 19-23, 2013; Chicago.

Disclosure: Little has no relevant financial disclosures.