Prognosis

Functional outcomes

A significant proportion of patients may still complain of stiffness (as high as 63% in one study), pain, and swelling, with differences in fracture pattern potentially playing a role.[65][66] There is insufficient evidence to support the recommendation of a particular patient reported outcome measure (PROM) for use in adult ankle fracture research based on Consensus Based Standards for the Selection of Health Measurement Instrument (COSMIN) methodology.[67]

Short musculoskeletal functional assessment/American Orthopedic Foot and Ankle Society Ankle Score

Using the short musculoskeletal functional assessment and the American Orthopedic Foot and Ankle Society Ankle Score, those with operatively-treated bimalleolar fractures have poorer functional outcome than those with operatively-treated lateral malleolar fractures and medial deltoid ligament rupture at 1 year.[68] Similarly, it has been reported that patients with a younger age, male sex, and the absence of diabetes mellitus have improved functional recovery at 1 year following operative stabilisation of ankle fractures.[69] There may also be a trend towards earlier functional recovery following operative ankle fracture stabilisation with early functional rehabilitation.[40][70]​​​

In those patients with operatively treated syndesmotic injuries, anatomical reduction of the syndesmosis may lead to improved functional recovery as measured by the short musculoskeletal functional assessment questionnaire.[13]

SF-36

In those patients with operatively-treated unstable ankle fractures there is a consistent improvement of health outcomes as measured by the SF-36 functional outcome score up to 2 years following injury.[71][72][73] However, at 2 years sub-scores of the SF-36 in the physical function domain may remain less than population norms.[71] Studies suggest that patients who smoke, have a lower level of education, and present with a medial malleolar fracture report lower physical function following operatively treated unstable ankle fractures.[71] Poorer results with regard to longer in-hospital stays and postoperative complications have also been identified in people with diabetes mellitus with operatively treated ankle fractures across all fracture morphologies.[74]

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