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.[66][67] 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.[68]

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.[69] 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 stabilization of ankle fractures.[70] There may also be a trend toward earlier functional recovery following operative ankle fracture stabilization with early functional rehabilitation.[44]​​[71]​

In those patients with operatively treated syndesmotic injuries, anatomic 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.[72][73][74] However, at 2 years subscores of the SF-36 in the physical function domain may remain less than population norms.[72] 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.[72] Poorer results as regards 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.[75]

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