Functional outcomes of unstable ankle fractures with and without syndesmotic fixation in the adolescent population

Abstract

Purpose: The purpose of this study was to compare functional outcomes of adolescents with and without ankle syndes-motic injuries and identify predictors of functional outcome after operative ankle fractures. Methods: A retrospective review was conducted on operative adolescent ankle fractures treated between 2009 and 2019 with a minimum of one-year follow-up (mean 4.35 years). Patients who underwent syndesmotic fixation (SF) (n = 48) were compared with operative ankle fractures without syn-desmotic injury (n = 63). Functional outcomes were assessed using standardized questionnaires, specifically the Foot and Ankle Ability Measure (FAAM) and Single Assessment Numer-ical Evaluation. Results: There were no differences in patient-reported out-comes, rates of return to sport or complications between groups with and without SF. The SF group had a longer tour-niquet time (p = 0.04), duration of non-weight-bearing (p = 0.01), more Weber C fibula fractures (p < 0.001), fewer me-dial malleolus fractures (p = 0.03) and more frequently underwent implant removal (p < 0.0001). Male sex, lower body mass index (BMI) and longer duration of follow-up were significant predictors of a higher FAAM sports score using multi-variable linear regression. SF was not a predictor of functional outcome. Conclusion: This study demonstrated that patients that un-dergo surgical fixation of syndesmotic injuries have equivalent functional outcomes compared to operative ankle fractures without intraoperative evidence of syndesmotic injury. We also identified that male sex, lower BMI and longer duration of follow-up are predictors of a good functional outcome. Level of Evidence: III.