Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
International Orthopaedics
Published in: International Orthopaedics 7/2012

01-07-2012 | Original Paper

Risk factors for post-traumatic osteoarthritis of the ankle: an eighteen year follow-up study

Authors: Anne Lübbeke, Davide Salvo, Richard Stern, Pierre Hoffmeyer, Nicolas Holzer, Mathieu Assal

Published in: International Orthopaedics | Issue 7/2012

Login to get access

Abstract

Purpose

Long-term studies evaluating risk factors for development of ankle osteoarthritis (OA) following malleolar fractures are sparse.

Methods

We conducted a retrospective cohort study including consecutive patients treated by open reduction and internal fixation for malleolar fracture between January 1988 and December 1997. Perioperative information was obtained retrospectively. Patients were evaluated clinically and radiographically 12–22 years postoperatively. Radiographic ankle OA was determined on standardised radiographs using the Kellgren and Lawrence scale (grade 3–4 = advanced OA). Uni- and multivariate regression analyses were performed to determine risk factors for OA.

Results

During the inclusion period, 373 fractures (372 patients; 9% Weber A, 58% Weber B, 33% Weber C) were operated upon. The mean age at operation was 42.9 years. There were 102 patients seen at follow-up (mean follow-up 17.9 years). Those not available did not differ in demographics and fracture type from those seen. Advanced radiographic OA was present in 37 patients (36.3%). Significant risk factors were: Weber C fracture, associated medial malleolar fracture, fracture-dislocation, increasing body mass index, age 30 years or more and length of time since surgery.

Conclusions

Advanced radiographic OA was common 12–22 years after malleolar fracture. The probability of developing post-traumatic OA among patients having three or more risk factors was 60–70%.
Literature
1.
Brown TD, Johnston RC, Saltzman CL, Marsh JL, Buckwalter JA (2006) Posttraumatic osteoarthritis: a first estimate of incidence, prevalence, and burden of disease. J Orthop Trauma 20(10):739–744PubMedCrossRef
2.
Saltzman CL, Salamon ML, Blanchard GM, Huff T, Hayes A, Buckwalter JA et al (2005) Epidemiology of ankle arthritis: report of a consecutive series of 639 patients from a tertiary orthopaedic center. Iowa Orthop J 25:44–46PubMed
3.
Valderrabano V, Horisberger M, Russell I, Dougall H, Hintermann B (2009) Etiology of ankle osteoarthritis. Clin Orthop Relat Res 467(7):1800–1806PubMedCrossRef
4.
Horisberger M, Valderrabano V, Hintermann B (2009) Posttraumatic ankle osteoarthritis after ankle-related fractures. J Orthop Trauma 23(1):60–67PubMedCrossRef
5.
Day GA, Swanson CE, Hulcombe BG (2001) Operative treatment of ankle fractures: a minimum ten-year follow-up. Foot Ankle Int 22(2):102–106PubMed
6.
De Vries JS, Wijgman AJ, Sierevelt IN, Schaap GR (2005) Long-term results of ankle fractures with a posterior malleolar fragment. J Foot Ankle Surg 44(3):211–217PubMedCrossRef
7.
Jarde O, Vives P, Havet E, Gouron R, Meunier W (2000) Malleolar fractures. Predictive factors for secondary osteoarthritis. Retrospective study of 32 cases. Acta Orthop Belg 66(4):382–388PubMed
8.
Stufkens SA, Knupp M, Horisberger M, Lampert C, Hintermann B (2010) Cartilage lesions and the development of osteoarthritis after internal fixation of ankle fractures: a prospective study. J Bone Joint Surg Am 92(2):279–286PubMedCrossRef
9.
Stufkens SA, van den Bekerom MP, Kerkhoffs GM, Hintermann B, van Dijk CN (2011) Long-term outcome after 1822 operatively treated ankle fractures: a systematic review of the literature. Injury 42:119–127PubMedCrossRef
10.
Beris AE, Kabbani KT, Xenakis TA, Mitsionis G, Soucacos PK, Soucacos PN (1997) Surgical treatment of malleolar fractures. A review of 144 patients. Clin Orthop Relat Res 341:90–98PubMedCrossRef
11.
Lindsjö U (1981) Operative treatment of ankle fractures. Acta Orthop Scand Suppl 189:1–131PubMed
12.
Müller J, Plaass U, Willenegger H (1971) Late results after surgically treated malleolar fractures. Helv Chir Acta 38(3):329–337PubMed
13.
Lorez LG, Hintermann B (1999) Significance of concomitant injuries in malleolar fractures. A prospective study. Unfallchirurg 102(12):949–954PubMedCrossRef
14.
Lindsjö U (1985) Operative treatment of ankle fracture-dislocations. A follow-up study of 306/321 consecutive cases. Clin Orthop Relat Res 199:28–38PubMed
15.
Danis R (1949) Théorie et pratique de l'ostéosynthèse. Masson, Paris
16.
Weber B (1966) Die Verletzungen des oberen Sprunggelenkes. Aktuelle Probleme in der Chirurgie. Huber, Stuttgart
17.
Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16(4):494–502PubMedCrossRef
18.
(2005) The atlas of standard radiographs of arthritis. Rheumatology (Oxford) 44 Suppl 4:iv46–iv72
19.
Kessler S, Guenther KP, Puhl W (1998) Scoring prevalence and severity in gonarthritis: the suitability of the Kellgren & Lawrence scale. Clin Rheumatol 17(3):205–209PubMedCrossRef
20.
LaValley MP, McAlindon TE, Chaisson CE, Levy D, Felson DT (2001) The validity of different definitions of radiographic worsening for longitudinal studies of knee osteoarthritis. J Clin Epidemiol 54(1):30–39PubMedCrossRef
21.
Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M (1994) Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int 15(7):349–353PubMed
22.
Fleischer GM, Warncke P (1989) Late results following ankle joint osteosyntheses. Zentralbl Chir 114(6):381–387PubMed
23.
Bergkvist D, Hekmat K, Svensson T, Dahlberg L (2009) Obesity in orthopedic patients. Surg Obes Relat Dis 5(6):670–672PubMedCrossRef
24.
Valtola A, Honkanen R, Kröger H, Tuppurainen M, Saarikoski S, Alhava E (2002) Lifestyle and other factors predict ankle fractures in perimenopausal women: a population-based prospective cohort study. Bone 30(1):238–242PubMedCrossRef
25.
Böstman OM (1994) Body mass index of patients with elbow and ankle fractures requiring surgical treatment. J Trauma 37(1):62–65PubMedCrossRef
26.
Spaine LA, Bollen SR (1996) ‘The bigger they come …’: the relationship between body mass index and severity of ankle fractures. Injury 27(10):687–689PubMedCrossRef
27.
Strauss EJ, Frank JB, Walsh M, Koval KJ, Egol KA (2007) Does obesity influence the outcome after the operative treatment of ankle fractures? J Bone Joint Surg Br 89(6):794–798PubMedCrossRef
28.
Böstman OM (1995) Body-weight related to loss of reduction of fractures of the distal tibia and ankle. J Bone Joint Surg Br 77(1):101–103PubMed
29.
Lauge-Hansen N (1950) Fractures of the ankle. II. Combined experimental-surgical and experimental-roentgenologic investigations. Arch Surg 60(5):957–985PubMedCrossRef
30.
Marsh JL, Slongo TF, Agel J, Broderick JS, Creevey W, DeCoster TA et al (2007) Fracture and dislocation classification compendium - 2007: Orthopaedic Trauma Association classification, database and outcomes committee. J Orthop Trauma 21(10 Suppl):S1–S133PubMedCrossRef
31.
Huch K, Kuettner KE, Dieppe P (1997) Osteoarthritis in ankle and knee joints. Semin Arthritis Rheum 26(4):667–674PubMedCrossRef
Metadata
Title
Risk factors for post-traumatic osteoarthritis of the ankle: an eighteen year follow-up study
Authors
Anne Lübbeke
Davide Salvo
Richard Stern
Pierre Hoffmeyer
Nicolas Holzer
Mathieu Assal
Publication date
01-07-2012
Publisher
Springer-Verlag
Published in
International Orthopaedics / Issue 7/2012
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI
https://doi.org/10.1007/s00264-011-1472-7

Other articles of this Issue 7/2012

International Orthopaedics 7/2012 Go to the issue

Original Paper

Cementation and interface analysis of early failure cases after hip-resurfacing arthroplasty

Original Paper

In vivo function of posterior cruciate ligament before and after posterior cruciate ligament-retaining total knee arthroplasty

Original Paper

Total hip replacement in developmental dysplasia using an oval-shaped cementless press-fit cup

Original Paper

Quantitative CT with finite element analysis: towards a predictive tool for bone remodelling around an uncemented tapered stem

Original Paper

The use of external fixation combined with vacuum sealing drainage to treat open comminuted fractures of tibia in the Wenchuan earthquake

Original Paper

Critical analysis of tibial fracture healing following unreamed nailing