Predictors of Time to Union After Operative Fixation of Closed Ankle Fractures.

Journal Article (Journal Article)

BACKGROUND: Ankle fractures are common and represent a significant burden to society. We aim to report the rate of union as determined by clinical and radiographic data, and to identify factors that predict time to union. METHODS: A cohort of 112 consecutive patients with isolated, closed, operative malleolar ankle fractures treated with open reduction and internal fixation was retrospectively reviewed for time to clinical union. Clinical union was defined based on radiographic and clinical parameters, and delayed union was defined by time to union >12 weeks. Injury characteristics, patient factors and treatment variables were recorded, and statistical techniques employed included the Chi-square test, the Student's T-test, and multivariate linear regression modeling. RESULTS: Forty-two (37.5%) of patients who achieved union did so in less than 12 weeks, and 69 (61.6%) of these patients demonstrated delayed union at a mean of 16.7 weeks (range, 12.1-26.7 weeks), and the remaining patient required revision surgery. Factors associated with higher rates of delayed union or increased time to union included tobacco use, bimalleolar fixation, and high energy mechanism (all p<0.05). In regression analysis, statistically significant negative predictors of time to union were BMI, dislocation of the tibiotalar joint, external fixation for initial stabilization and delay of definitive management (all p<0.05). CONCLUSION: Patient characteristics, injury factors and treatment variables are predictive of time to union following open reduction and internal fixation of closed ankle fractures. These findings should assist with patient counseling, and help guide the provider when considering adjunctive therapies that promote bone healing. LEVELS OF EVIDENCE: Prognostic, Level IV: Case series.

Full Text

Duke Authors

Cited Authors

  • Matson, AP; Hamid, KS; Adams, SB

Published Date

  • August 2017

Published In

Volume / Issue

  • 10 / 4

Start / End Page

  • 308 - 314

PubMed ID

  • 27872379

Electronic International Standard Serial Number (EISSN)

  • 1938-7636

Digital Object Identifier (DOI)

  • 10.1177/1938640016677813


  • eng

Conference Location

  • United States