scholarly journals Early weight bearing compared with non-weight bearing functional mobilization after operative treatment of an ankle fracture

2012 ◽  
Vol 7 (1) ◽  
pp. 40-46
Author(s):  
KP Paudel
Keyword(s):  
Internal Fixation ◽  
Operative Treatment ◽  
Ankle Fracture ◽  
Subjective Evaluation ◽  
Weight Bearing ◽  
Randomized Study ◽  
T Test ◽  
Ankle Fractures ◽  
Early Weight Bearing

Ankle fractures are the most common types of fractures treated in orthopaedics. When to begin ankle movement and weight bearing and the type of immobilizing devices to use post-operatively have had more intense clinical study than most other aspects of ankle fracture treatment. Aim of this study is to compare the results of two functional methods of post-operative treatment in internally fixed ankle fractures, i.e. one after early weight bearing using walking plaster and the other after non-weight bearing functional mobilization in the first six weeks following stable internal fixation. This is a prospective, non-randomized study. Between March 2004 and February 2006, thirty- five patients with displaced ankle fractures treated by internal fixation were assigned in a way that every alternate patient fell in different groups. Group A patients, 17, were managed with a below-knee walking plaster and group B patients, 18 with non-weight bearing mobilization with crutches. Five patients were lost in follow up and 30 were followed regularly as in the protocol. There was a temporary benefit in subjective evaluation (63 v 48 points, student t test. P=0.262), return to work (53.8 v 72.9 days, student t test, p=0.079) for those with a below-knee walking plaster at six week. There were minimal differences between the groups in the loss of dorsal range of movement (14.7 v 13.1 degree) or in the overall clinical results at the first follow up. But the differences disappeared in any evaluation after three months. Both treatments were considered to be satisfactory and the treatment choice depends on the ability to mobilize or weight bearing, the type of work and personal preference. DOI: http://dx.doi.org/10.3126/jcmsn.v7i1.5972 JCMSN 2011; 7(1): 40-46

scholarly journals Protocol for the Weight-bearing in Ankle Fractures (WAX) trial: a multicentre prospective non-inferiority trial of early versus delayed weight-bearing after operatively managed ankle fracture

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
C. P. Bretherton ◽  
H. A. Claireaux ◽  
J. Achten ◽  
A. Athwal ◽  
S. J. Dutton ◽  
...  
Keyword(s):  
Ankle Fracture ◽  
Weight Bearing ◽  
Treatment Options ◽  
Health Economic Evaluation ◽  
Cost Effective ◽  
Primary Outcome Measure ◽  
Ankle Fractures ◽  
Early Weight Bearing ◽  
Related Quality ◽  
Post Randomisation

Abstract Background Unstable ankle fractures represent a substantial burden of disease, accounting for a mean hospital stay of nine days, a mean cost of £4,491 per patient and 20,000 operations per year. There is variation in UK practice around weight-bearing instructions after operatively managed ankle fracture. Early weight-bearing may reduce reliance on health services, time off work, and improve functional outcomes. However, concerns remain about the potential for complications such as implant failure. This is the protocol of a multicentre randomised non-inferiority clinical trial of weight-bearing following operatively treated ankle fracture. Methods Adults aged 18 years and over who have been managed operatively for ankle fracture will be assessed for eligibility. Baseline function (Olerud and Molander Ankle Score [OMAS]), health-related quality of life (EQ-5D-5L), and complications will be collected after informed consent has been obtained. A randomisation sequence has been prepared by a trial statistician to allow for 1:1 allocation to receive either instruction to weight-bear as pain allows from the point of randomisation, two weeks after the time of surgery (‘early weight-bearing’ group) or to not weight-bear for a further four weeks (‘delayed weight -bearing’ group). All other treatment will be as per the guidance of the treating clinician. Participants will be asked about their weight-bearing status weekly until four weeks post-randomisation. At four weeks post-randomisation complications will be collected. At six weeks, four months, and 12 months post-randomisation, the OMAS, EQ-5D-5L, complications, physiotherapy input, and resource use will be collected. The primary outcome measure is ankle function (OMAS) at four months post-randomisation. A minimum of 436 participants will be recruited to obtain 80% power to detect a non-inferiority margin of -6 points on the OMAS 4 months post-randomisation. A within-trial health economic evaluation will be conducted to estimate the cost-effectiveness of the treatment options. Discussion The results of this study will inform national guidance with regards to the most clinically and cost-effective strategy for weight-bearing after surgery for unstable ankle fractures. Trial registration ISRCTN12883981, Registered 02 December 2019.

scholarly journals Immediate Weight Bearing and Range of Motion After Internal Fixation of Unstable Ankle Fractures: A Retrospective Controlled Study

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0021
Author(s):  
Brianna R. Fram ◽  
Ryan G. Rogero ◽  
Daniel Corr ◽  
Gerard Chang ◽  
James Krieg ◽  
...  
Keyword(s):  
Risk Factors ◽  
Internal Fixation ◽  
Range Of Motion ◽  
Ankle Fracture ◽  
Weight Bearing ◽  
Ankle Fractures ◽  
Controlled Study ◽  
Posterior Malleolus ◽  
Significant Difference ◽  
Operative Complications

Category: Ankle; Trauma Introduction/Purpose: Ankle fractures are the third most common adult fractures. Further, they are the second most common fracture type to require inpatient admission, behind only hip fractures, despite occurring in a population on average nearly 30 years younger. There is evidence that early or immediate weight bearing and range of motion may be safe following ankle fracture fixation, but existing studies are small and largely exclude patients with syndesmotic or posterior malleolar fixation. We therefore studied the safety of immediate weight bearing as tolerated (IWBAT) and immediate range of motion (IROM) following open reduction internal fixation (ORIF) of unstable ankle fractures in a diverse cohort and attempted to identify risk factors for complications. Methods: We performed a retrospective case-control study. Out of 268 patients who underwent primary ORIF of an unstable ankle fracture from 2013-18, we identified 133 (49.6%) who were IWBAT and IROM. The treating surgeon excluded patients from IWBAT if they had an ipsilateral leg injury requiring non-weight bearing, a large displaced posterior malleolus fragment, or Maisonneuve injury with fracture of the proximal fibula. We used propensity-score matching to identify 172 controls who were non-weight bearing (NWB) and no range of motion for 6 weeks post-op. We reviewed medical records and radiographs for demographic, injury and treatment characteristics. Our primary outcome was complications. We compared demographics, injury characteristics, treatment episode, and complications between the IWBAT and NWB groups and performed within group analysis to identify risk factors for complications. A p-value <0.05 was considered significant. Results: The groups did not differ significantly in age, BMI, Charleston Comorbidity Index (CCI), smoking status, diabetes status, malleoli involved, percentages undergoing medial malleolus (60.9% IWBAT vs. 51.7% NWB, p=0.11), posterior malleolus (24.1% IWBAT, 26.7% NWB, p=0.59), or syndesmosis fixation (41.4% IWBAT, 42.4% NWB, p=0.85). There was no significant difference in total complications (9.8% IWBAT vs. 12.8% NWB, p=0.41), nonoperative complications (6.8% IWBAT vs. 8.7% NWB, p=0.53), or operative complications (3.8% IWBAT vs. 4.1% NWB, p=0.89). We did not identify any factors associated with increased complication risk, including posterior malleolus or syndesmosis fixation, diabetes, age, CCI or pre-injury assisted ambulation. Conclusion: IWBAT and IROM may be safe following ankle fracture ORIF in a broader patient population than previously believed. We did not identify specific risk factors for post-operative complications. Further study on patient selection may allow for more extensive use of this protocol to reduce the morbidity associated with unstable ankle fractures. [Table: see text]

scholarly journals Early Weight Bearing on Weber C Fractures with Retained Syndesmotic Screws

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000
Author(s):  
Cristian Ortiz ◽  
Andres Keller Díaz ◽  
Pablo Mococain ◽  
Pablo Wagner ◽  
Ruben Radkievich ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Weight Bearing ◽  
Ankle Fractures ◽  
X Rays ◽  
Aofas Score ◽  
Early Weight Bearing ◽  
Clear Space ◽  
Screw Breakage ◽  
The Mean

Category: Ankle, Sports, Trauma Introduction/Purpose: There is no consensus about when to allow weight bearing in ankle fractures treated with syndesmotic screw fixation. There has been no evaluation of the radiographic fate of the syndesmosis when syndesmotic screws are retained and early weight bearing is encouraged, or the clinical result depending on the screw status, which can be intact, broken or loose. Our objective was to evaluate the radiographic and clinical parameters of patients who had a screw fixation of the syndesmosis and early weight bearing was allowed. Our hypothesis was that no difference would be observed on syndesmotic reduction or clinical function depending on the screw status. Methods: We analyzed 42 patients with ankle fractures treated with syndesmotic screws in which early weight bearing was allowed (3 weeks postoperatively). Weight bearing radiographs were obtained at 2 weeks, 2 months and at final follow up (41.2 months). Radiologically we measured medial clear space (MCS), tibiofibular overlap (OL), tibiofibular clear space (CS), talar shift (TS) and screw condition (intact, broken, loose). Clinical function was measured with the AOFAS score and stratified by the screw condition. Statistical analysis was performed with the SPSS software and a non-inferiority confidence interval for the mean was calculated. Results: At final follow up, 66,6% of the screws were broken, 30,9% showed significant loosening and only 1 patient (4,7%) had a screw that remained solid with no signs of osteolysis. MCS at 2 weeks, 2 months and at final follow up was 2,94 mm; 3,03 mm; 3,02, respectively. OL was 6,76 mm; 6,78 mm; 6,83 and CS was 4,26 mm; 4,66 mm; 4,6 mm. No TS was detected. There was no difference in measurements along time (p>0,05). Relative to clinical function, the mean AOFAS score was 95 points. No difference was found between the clinical scores of patients stratified by the screw condition (p>0,05). Conclusion: Early weight bearing on a fixed syndesmosis appears to be safe, with no measurable radiographic or clinical consequences regarding ankle joint function. Despite screw breakage or loosening on x-rays, loss of reduction is seldom observed. We suggest that routine removal of syndesmotic screws is not necessary in these group of patients.

Association of Bleeding Disorders and Risk of Complications Following Open Reduction and Internal Fixation of the Ankle

2021 ◽  
pp. 107110072110581
Author(s):  
Alisa Malyavko ◽  
Theodore Quan ◽  
William T. Stoll ◽  
Joseph E. Manzi ◽  
Alex Gu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Postoperative Complications ◽  
Internal Fixation ◽  
Operative Treatment ◽  
Ankle Fracture ◽  
Open Reduction ◽  
Bleeding Disorder ◽  
Ankle Fractures ◽  
Bleeding Disorders ◽  
Increased Risk

Background: Open reduction and internal fixation (ORIF) of the ankle is a common procedure performed to correct ankle fractures in many different patient populations. Diabetes, peripheral vascular disease, and osteoporosis have been identified as risk factors for postoperative complications following surgery for ankle fractures. To date, there have not been any studies evaluating postoperative outcomes in patients with bleeding disorders undergoing operative treatment for ankle fractures. The aim of this study was to determine the postoperative complication rate following ORIF of the ankle in patients with a bleeding disorder vs those without a bleeding disorder. Methods: From 2006 to 2018, patients undergoing operative treatment for ankle fracture were identified in the National Surgical Quality Improvement Program database. Two patient cohorts were defined: patients with a bleeding disorder and patients without a bleeding disorder. Patients who underwent either inpatient or outpatient ORIF of the ankle were included in this study. In this analysis, demographics, medical comorbidities, and postoperative complications variables were assessed between the 2 cohorts. Bivariate and multivariate analyses were performed. Results: Of 10 306 patients undergoing operative treatment for ankle fracture, 9909 patients (96.1%) had no bleeding disorder whereas 397 patients (3.9%) had a bleeding disorder. Following adjustment on multivariate analysis, compared to patients who did not have a bleeding disorder, those with a bleeding disorder had an increased risk of any postoperative complications (odds ratio [OR] 1.48, 95% confidence interval [CI] 1.05-2.08, P = .024), requirement for postoperative blood transfusion (OR 2.86, 95% CI 1.53-5.36, P = .001), and extended length of hospital stay greater than 5 days (OR 1.46, 95% CI 1.10-1.93, P = .010). Conclusion: Patients with bleeding disorders are associated with increased risk of postoperative complications following ORIF for ankle fractures. Determining patient risk factors and creating optimal preoperative and perioperative management plans in patients with bleeding disorders undergoing ORIF can be beneficial in reducing postoperative complications, improving patient outcomes, and reducing overall morbidity. Level of Evidence: Level III, retrospective cohort study.

scholarly journals Timing of Open Reduction and Internal Fixation of Ankle Fractures

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0003
Author(s):  
Direk Tantigate ◽  
J. Turner Vosseller ◽  
Justin Greisberg ◽  
Benjamin Ascherman ◽  
Christina Freibott ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Functional Outcome ◽  
Functional Outcomes ◽  
Ankle Fracture ◽  
Open Reduction ◽  
Demographic Variables ◽  
Ankle Fractures ◽  
Significant Difference ◽  
The Mean

Category: Ankle, Trauma Introduction/Purpose: Unstable ankle fractures are typically treated with open reduction and internal fixation (ORIF) for stabilization in an effort to ultimately prevent post-traumatic arthritis. It is not uncommon for operative treatment to be performed as an outpatient in the ambulatory surgery setting several days to a couple weeks after the injury to facilitate things from a scheduling perspective. It is unclear what effect this delay has on functional outcome. The purpose of this study is to assess the impact of delayed operative treatment by comparing the functional outcomes for groups of patients based on the amount of time between the injury and surgery. Methods: A retrospective chart review of 122 ankle fracture patients who were surgically treated by ORIF over a three year period was performed. All ankle fracture patients older than 18 years with a minimum of 24 months of follow-up were included. A total of 61 patients were included for this study. Three patients were excluded; 2 patients had an open injury and 1 patient presented with a delayed union. Demographic data, comorbidities, injury characteristics, duration from injury to surgery, operative time, length of postoperative stay, complications and functional outcomes were recorded. Functional outcome was determined by Foot and Ankle Outcome Score (FAOS) at the latest follow-up visit. Comparison of demographic variables and the subcategory of FAOS including symptoms, pain, activities of daily living (ADL), sport activity and quality of life (QOL) was performed between patient underwent ORIF less than 14 days after injury and 14 days or greater. Results: A total of 58 patients were included in this study. Thirty-six patients (62.1%) were female. The mean age of patients was 48.14 ± 16.84 years (19-84 years). The mean follow-up time was 41.48 ± 12.25 months (24-76 months). The duration between injury and operative fixation in the two groups was 7 ± 3 days (<14 days) and 18 ± 3 days (>14 days), respectively. There was no statistically significant difference in demographic variables, comorbidities, injury characteristics, or length of operation. Each subcategory of FAOS demonstrated no statistically significant difference between these two groups. (Table 1) Additionally, further analysis for the delayed fixation more than 7 days and 10 days also revealed no significant difference of FAOS. Conclusion: Open reduction and internal fixation of ankle fracture more than 14 days does not significantly diminish functional outcome according to FAOS. Delay of ORIF for ankle fractures does not play a significant role in the long-term functional outcome.

Clinico-Radiological Outcome after Surgical Interventions in Ankle Fractures at a Tertiary Care Centre in Moradabad, Uttar Pradesh

2021 ◽  
Vol 8 (26) ◽  
pp. 2265-2270
Author(s):  
Amit Saraf ◽  
Manish Singhal ◽  
Najmul Huda
Keyword(s):  
Internal Fixation ◽  
Ankle Joint ◽  
Scoring System ◽  
Ankle Fracture ◽  
Cartilage Damage ◽  
Ankle Fractures ◽  
Joint Surface ◽  
Radiological Outcome ◽  
Surgical Fixation

BACKGROUND Ankle fractures are among the most common injuries encountered by orthopaedic surgeons. An ankle is considered unstable when the loss of normal constraints around the ankle permits the talus to move in a non-physiologic pattern. Under such circumstances, the dynamic joint surface contact area within the ankle is diminished, which predisposes to articular cartilage damage and premature degeneration. In today’s time, many modalities are available for surgical fixation of bimalleolar fractures. Such interventions restore anatomy and biomechanics of the ankle joint. Even though there are plethora of foreign studies on similar matter, deficiency of such analysis has been depicted in literature from developing countries, particularly from South-East Asian region. In this study, we wanted to assess various methods of internal fixation in ankle fracture & evaluate their clinical and radiological outcome post-operatively. METHODS 26 ankle fracture patients in the age group of 18 - 60 years were included in this study. Fractures were classified pre-operatively based on Lauge-Hansen classification. Patients were followed up at regular intervals of 1st, 2nd, 3rd, 6th & 12 month after surgery and assessed by Baird and Jackson scoring system based on subjective, objective and radiographic criteria. Complications like infection, arthritis, stiffness & implant failure were assessed on regular follow-up. RESULTS Variety of methods (including k-wires, plates & screws) were used for surgical fixation. Majority of fractures resulted from road traffic accident (RTA). Patients were evaluated using Baird & Jackson scoring system during follow-up at 1st, 2nd , 3 rd, 6th & 12 month. All patients had poor scores for initial 3 months. Patients showed good to excellent result on final follow-up at 9 to 12 months after surgery. Complications were observed in 19 % cases with arthritis being most common. CONCLUSIONS Open reduction and internal fixation restores the articular congruity of the ankle joint. The operative result was satisfactory with good clinical outcome. KEYWORDS Ankle, Fracture, Anatomy, Modalities

scholarly journals Low Risk of Displacement with Early Weight Bearing of the Isolated Weber B Fracture: Results of a New Treatment Protocol

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0034
Author(s):  
N. Jane Madeley ◽  
Nnamdi Obi ◽  
Chinnasamy Senthil Kumar ◽  
Lech Rymaszewski
Keyword(s):  
Operative Treatment ◽  
Weight Bearing ◽  
Treatment Protocol ◽  
Ligament Injury ◽  
Post Injury ◽  
Early Weight Bearing ◽  
Fracture Clinic ◽  
Early Results ◽  
Significant Difference

Category: Trauma; Ankle Introduction/Purpose: Truly isolated Weber B distal fibula fractures are stable injuries that usually recover well following non- operative treatment, however the concern over the possibility of a medial ligament injury, and ankle instability has traditionally lead to regular surveillance in the fracture clinics to exclude delayed talar shift developing. After recent studies suggesting this risk is low we introduced a new functional treatment protocol and present our early results. Methods: 141 consecutive patients presenting acutely with isolated Weber B fractures without talar shift during a 12 months period were included. ED notes and radiographs were reviewed. All patients were splinted in a removable boot, and allowed to fully weight bear up to their comfort levels. Patients without signs of a medial ligament injury were then discharged from follow-up with advice to wear the boot for 6 weeks, an information leaflet and exercise sheet and a helpline number in case of difficulties. If they wanted clinic review this was organised. If signs of a medial ligament injury were documented, or the medial findings were not clear the patient was reviewed with up to date radiographs in the fracture clinic at 4 weeks post-injury. If talar shift developed the patient was to be converted to operative treatment. Olerud and Molander scores were collected between 6 and 12 months post- injury. Results: There were 51 patients without signs of medial ligament injury and of these 23 were discharged according to protocol and 28 patients attended fracture clinic. 89 patients had signs of medial ligament injury or no documented medial findings and of these 65 attended fracture clinic. One discharged patient re-accessed care. Of 93 patients reviewed in the fracture clinic none developed delayed talar shift. One underwent delayed ORIF for ongoing fibula discomfort and the remainder continued with non- operative treatment. 99 (70%) patients provided outcome scores. The mean Olerud and Molander score at a minimum of 6 months follow-up was 87 and the median score was 100. No significant difference was found between treatment arms. The scores were comparable to those in the published literature. Conclusion: We conclude the risk of delayed talar shift is low and satisfactory outcomes can be safely achieved with our functional protocol. Additional tests/imaging to establish the integrity of the medial ligament may be unnecessary.

Effect of Early Weight Bearing on Outcomes After Open Reduction and Internal Fixation of Trimalleolar Ankle Fractures

Orthopedics ◽  
2021 ◽  
Author(s):  
Devon M. Myers ◽  
Sergio H. Pulido ◽  
Shane Forsting ◽  
Benjamin Umbel ◽  
Benjamin C. Taylor
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Weight Bearing ◽  
Ankle Fractures ◽  
Early Weight Bearing

scholarly journals Outcomes of Primary Tibiotalocalcaneal Nailing for Complicated Diabetic Ankle Fractures

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0016
Author(s):  
M Pierce Ebaugh ◽  
Benjamin Umbel ◽  
Benjamin Taylor ◽  
David Goss
Keyword(s):  
Hospital Stay ◽  
Limb Salvage ◽  
Weight Bearing ◽  
Ankle Fractures ◽  
Definitive Treatment ◽  
Diabetic Patients ◽  
Charcot Arthropathy ◽  
Early Weight Bearing ◽  
Ambulatory Status

Category: Trauma, Ankle, Ankle Arthritis Introduction/Purpose: Ankle fractures in complicated diabetic patients (i.e. presence of neuropathy, nephropathy, or peripheral vascular disease) have significantly increased rates of complications with markedly worse functional outcomes. Current management advocates for operative intervention due to high rates of fracture reduction loss and Charcot arthropathy in those treated nonoperatively. Tibiotalocalcaneal (TTC) nails have been reported in the literature as a salvage option when initial ankle stabilization has failed. We hypothesize that the minimally invasive, robust construct that primary TTC fixation with an intramedullary nail offers will result in high rates of limb salvage, acceptable rates of complications, and nominal loss of function. Thus, the purpose of this study was to evaluate the outcomes of primary TTC intramedullary nailing for definitive treatment of neuropathic ankle fractures. Methods: This was an IRB approved retrospective study of 27 complicated diabetic patients who underwent TTC nailing of their ankle fracture as a primary treatment without formal joint preparation. The study was undertaken at an urban Level 1 trauma center. Complicated diabetes was defined as having one or more of the following formal diagnoses: neuropathy (20 patients), nephropathy (4), PVD (3). Mean clinical follow up was 888 days (range 21-2843 days). Patients were screened for associated risk factors such as open fracture, neuropathy, nicotine and alcohol abuse, obesity and elevated Hba1c. Data was also collected on surgical complications such as superficial and deep infection, wound dehiscence, amputation, revision fixation, hardware failure, malunion, nonunion. Outcomes were measured in length of hospital stay, loss of ambulatory level, and time to death. Results: The mean age was 66 (32-92) years with an average BMI of 38 (21-68). Six of 27 fractures were open and 20 of 27 patients were neuropathic. Mean hemoglobin A1C was 7.4 (5.5-13). Average hospital stay was 6 days (0-22). The average patient was fully weight bearing at 6 weeks (1-17). Two patients underwent removal of hardware, due to pain and proximal screw failure respectively. One patient required formal arthrodesis. There were no malunions, symptomatic nonunions, or instances of Charcot arthropathy. Two patients underwent repeat debridement for infection, resulting in antibiotic nail placement and above knee amputation respectively. A total of eight patients had died by final follow up (mean 1048 days) from index procedure. Overall, mean ambulatory status was maintained. Conclusion: Primary tibiotalocalcaneal nailing is a viable alternative to previously described methods of fixation of complicated diabetic ankle fractures. With high limb salvage rates, early weight bearing, maintained ambulatory status and low rates of return to the operating room, our technique can be considered an applicable approach to increase overall survivability of threatened limbs and lives with acceptably low complications.

scholarly journals Mismanaged Ankle Fractures, is it too Late to Save the Joint?

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0009
Author(s):  
Mohamed M. Abd-Ella
Keyword(s):  
Operative Treatment ◽  
Weight Bearing ◽  
Young Patients ◽  
Primary Treatment ◽  
Good Prognosis ◽  
Ankle Fractures ◽  
Deltoid Ligament ◽  
Posterior Malleolus ◽  
Reasonable Range

Category: Trauma; Ankle Introduction/Purpose: Mimanaged ankle fractures with a short fibula, talat shift, syndesmotic widening, malunion or nonunion following inappropriate conservative treatment or inadequate operative treatment are very challenging, especially in young patients. Whether or not to revise the fracture fixation after a period of time with weight bearing with a malaligned joint is a difficult question regarding the value of the operation after that time to prevent arthritis.The aim of the study was to evaluate the effect of operative intervention in these cases in improving symptoms and preventing arthritis Methods: The study was a prospective study. Inclusion criteria were mismanaged ankle fractures with a reasonable range of motion. Exclusion criteria were infection, severe arthritis, complete loss of motion, ischemia and diabetes. Standing radiographs for both limbs and CT scans were obtained for all patients to analyze the problem. Operative treatment was planned accordingly, and regular follow up was performed clinically and radiologically. Results: 29 patients were included. The average duration from the primary injury or primary fixation was 6 months (range 1.5 to 28 months). The lateral malleolus with or without the syndesmosis were affected in 25 out of 29 cases, the posterior malleolus was affected in 2 cases, the medical malleolus in 6 cases and the deltoid ligament in 12 cases. The minimum follow up duration was 9 months with a range from 9 months to 6 years. Three patients required an ankle fusion later. Ten patients report excellent results, 10 patients report good results, 4 patients report fair results and five patients report bad results, three of them underwent ankle arthrodesis.AOFAS score improved significantly from a mean of 28 points preoperative to a mean 85 points postoperative. Conclusion: Perfect primary treatment for ankle fractures is the best method for a good prognosis, but it is not late to reconstruct the joint if there is a reasonable range of motion.This can give good results and delay fusion, and it can make arthroplasty a valid option by restoring ankle anatomy and stability.

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