OPERATIVE VS NON OPERATIVE MANAGEMENT OF ANKLE INJURIES – A COMPARITIVE ANALYSIS

Sudesh Chander Sharma*, Sonali Sharma and Shashi Sudan

ABSTRACT

Ankle is a complex weight bearing hinge joint formed by distal tibia, fibula and talus, with dorsiflexion, plantarflexion as its principal movements combined with limited rotatory and sliding capability. The joint is prone to low velocity injuries like twisting sprains, strains, osteoporotic fractures,as well as high velocity trauma like sports injuries, road traffic accidents, resulting in supination / pronation external rotation injuries and also supination adduction / Pronation Abduction injuries (Lauge-Hansen). Having understood the mechanism of injury as described by Lauge-Hausen,these injuries can be treated by closed reduction and POP Cast especially in low demand, minimally displaced fractures successfully in good percentage of cases. But, conservative method is associated with high rate of redisplacement, malunion, nonunion, stiffness, osteoporosis and secondary osteoarthritis.Because of these limitations, there is a trend to treat these unstable fractures with a more definitive treatment in the form of anatomical open reduction – internal fixation followed by fast mobilisationto achieve better functional outcome. A prospective study to compare clinical, radiological and functional outcome as per Olerud and Molander score, was done. Our study with a mean follow up of 26 months, included 140 patients, devided in two groups, A and B of 75 and 65 patients, treated by operative and non-operative methods respectively. The group A had 53 (70.6%) males and 22 (29.4%) females, compared to group B, 27 (41.5%) males and 38 (58.5% ) females. Age ranged from 20 to 80 years (mean age = 29.5 gr.A and 48 gr.B). Common mode of trauma, in group A was motor vehicular accidents 45 (60%) and low energy trauma, twisting, slipping, missing a step was common 45 (61.5%) in groupB. Fractures were classified as per Lauge-Hansen and there were 30 (21.4%) PER III, 28 (20%) SER IV, 25 (17.8%) PER IV, 20 (14.2%) SERIII, 19 (13.5%) PER II, and 18 (13.1%) SER II. Group A, patients were mostly treated by open reduction and internal fixation, using 1-2 cancellous cannulated 4 mm screws for fixation for medial malleolus and 1/3rd tubular plate for fibular fixation. Group B, patients were treated by closed reduction and long leg POP Cast. The overall comparative results as per Olerud and Molander scoring revealed, significant superiority of operative group A over conservative Group B (p = 0.035).

Keywords: Operative-non operative, Comparison, Ankle Fracture.