Functional and radiological outcomes of closed ankle fractures managed non-operatively among adults at Mulago National Referral Hospital six months post-injury

Abstract

Introduction Non-operative management is a common approach for treating closed ankle fractures at Mulago National Referral Hospital (MNRH) due to its potential benefits, including shorter hospital stays and the absence of surgical risks. Evaluating functional and radiological outcomes is essential for determining the success of this treatment. This study aimed to evaluate the functional and radiological outcomes of ankle fractures managed non-operatively and to identify the factors associated with these outcomes. Methods; This study conducted from December 2023 to March 2024 evaluated these outcomes and associated factors in 93 adult ankle fracture patients treated non-operatively at MNRH. Using the American Orthopedic Foot Ankle Society ankle and hind foot score tool for functional scores and examining radiographs for union and parameters like the medial clear space, tibiofibular overlap, tibiofibular clear space, and the talocrural angle, the study aimed to identify the efficacy of non-operative management. Data analysis using STATA was conducted to assess the functional and radiological outcomes. Results The mean age and standard deviation were 41+/-12 years. More females n=49(52.7%) had ankle fractures than males. The commonest fracture type was Weber B n=65(69.9%)> Weber C n=16(17.2%)> Weber A n=12 (12.9%). The majority of the patients had an AOFAS-AH score categorized as good (54.8%)>excellent (23.7%)>fair (16.1%)>poor (5.4%). 86(92.5%) of the patients had radiological union with 7(7.5%) having nonunion. 97.7% of the patients had a normal MCS, 80.2% normal TFO, 50% normal TCA, and 13.9% normal TFCS. Significant predictors of poor functional outcomes included being HIV-positive (adjusted odds ratio [95% CI] 0.02 [0.01-0.21], p-value 0.001), Weber B fractures (adjusted odds ratio [95% CI] 0.19 [0.04-0.77], p-value 0.020), and Weber C fractures (adjusted odds ratio [95% CI] 0.16 [0.03-0.87], p-value 0.034). Predictors of good functional outcomes included receiving physiotherapy (adjusted odds ratio [95% CI] 4.45 [1.67-11.90], p-value 0.003) and initiating weight bearing at 4-6 weeks (adjusted odds ratio [95% CI] 5.09 [1.60-1620], p-value 0.006) or after 6 weeks (adjusted odds ratio [95% CI] 4.20 [1.42-1243], p-value 0.009). Conclusion: The majority of participants achieved radiological union, though all united fractures resulted in malunion. Worse functional outcomes were associated with Weber classifications B and C, as well as HIV-positive status.