The importance of anatomical reduction in the functional outcome of open ankle fractures.

Introduction: Whilst closed ankle fracture injuries are common, well characterized and have treatment guidelines derived from the literature, open ankle fractures are rare and are not well studied. The few studies that exist are from the developed First World and these well resourced circumstances are not available in most parts of the world. The purpose of this prospective study was to assess the functional outcomes of open ankle fractures and the factors associated with their outcome in an adult population in rural South Africa.

Methods: This prospective study was done at a referral hospital in a rural and semi-rural part of South Africa during the study period from January 1, 2013 until April 30, 2019 and was a retrospective chart review of 59 adult patients who sustained open ankle fractures. Pre-, peri- and postoperative factors in the chart review were assessed for each patient. Twenty-one patients were available for follow-up and were reviewed at least 6 months post injury for a functional assessment using the American Orthopedic Foot and Ankle Society Score (AOFAS).

Results: The average AOFAS was 68,2 out of 100 (fair outcome). The lowest score recorded was 38 (one patient) and the highest score 95 (two patients). Nine patients presented with a poor outcome (<60), six with a fair outcome (60-79), two with a good outcome (80-89) and four with an excellent outcome (90-100). The only significant finding, using a Fisher's exact test, indicated that anatomical reduction of the fracture lead to a fair, good or excellent outcome compared to a non-anatomical reduction leading to a poor functional outcome (p = 0,046).

Conclusions: Our results showed that open ankle fractures are serious injuries with a very variable outcome when managed in a rural or semi-rural setting and that anatomical reduction is required to achieve an optimal functional outcome.