Study of factors affecting the outcome of operative management of malleolar fractures

Introduction: One of the most common fractures an orthopaedic surgeon encounters is Malleolar fractures. As with all intra articular fractures accurate reduction and stable internal fixation of malleolar fractures is desirable. The present study aimed at analyzing the factors influencing the outcome of operative management of malleolar fractures. Materials and Methods: In this prospective study 25 patients with Malleolar fractures who were surgically treated between 2014 to 2016 were included. All patients were treated in accordance with A.O. principles. Patients aged above 18 years, with unstable fractures were included in this study. Post op protocol was below knee POP cast with a dorsal window for ankle mobilization and non-weight bearing walking with walker for 4 weeks post operatively. Baird and Jackson ankle scoring system was used to analyze the results. The follow up period for all patients was 60 weeks. Results: In this series of fixation of malleolar fractures with various techniques had Fair results in 84% and poor results in 16% as per Baird and Jackson Score. The average time to union was 12 weeks. The complications leading poor result were instability, Pain at rest, arthritic changes. Conclusion: Open reduction and internal fixation guaranty high standard of reduction besides eliminating the chances of loss of reduction. In our study, the Extent of anatomical reduction achieved in the surgery and Post-operative ankle mobilization and patients' compliance influenced the outcome. Restoration of fibular length and rotation is critical in re-establishing a stable ankle mortise and perfect talar alignment. We conclude tension band wiring is the preferred method for small fracture fragments and osteoporotic bones of both medial and lateral malleolus.