Early complications of surgically managed ankle fractures related to the AO classification - A review of 118 ankle fractures treated with open reduction and internal fixation

The charts of 118 consecutive ankle fractures were reviewed. The patients' age, sex, energy of trauma, hospital stay, need for traction therapy, syndesmosis fixation and soft-tissue problems were related to the various types of fractures according to the AO classification. An interobserver check study revealed an agreement of 0.61 (kappa), which is considered good. The age of the patients with A-fractures was 33 years (SD +/- 13), B-fractures 56 years (SD +/- 18), and C-fractures 48 years (SD +/- 16). The age differences within these groups were highly significant (P < 0.005). The highest average ages were found in the patients with B2 and B3 type fractures, 57 and 61 years, respectively. Women were significantly older than men (P < 0.0001), and 61% of the patients were women. Perioperative problems, such as wound margin necrosis and infections, were significantly related to fracture types B2 and B3. Preoperative traction therapy was necessary in the least stable fractures, of which all but one C1 fracture were B2/3 type fractures. The energy of trauma was not related to perioperative problems. The period of hospitalisation was significantly longer in the patients with B2/B3 type fractures (P < 0.001). Judging by the significantly higher incidence of perioperative complications, longer hospital stay, and predominance of instability and skin damage in the AO B2 and B3 type fractures, these fractures may benefit from more attentive and urgent care.