Patients with more complex ankle fractures are associated with poorer patient-reported outcome: an observational study of 11,733 patients from the Swedish Fracture Register
DOI:
https://doi.org/10.2340/17453674.2024.40607Keywords:
Foot and ankle, Fractures, OutcomeAbstract
Background and purpose: Patient-reported outcome measures (PROMs) following ankle fractures, including all fracture types, have not been reported. It is therefore unclear whether fracture morphology correlates with outcome. We aimed to analyze PROMs in patients with an ankle fracture in relation to the Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) fracture classification using population-based register data from the Swedish Fracture Register (SFR).
Methods: All patients aged ≥ 18 years with an ankle fracture (AO/OTA 44A1–C3) registered in the SFR between 2012 and 2019 were retrieved from the register. Patients with completed PROM questionnaires (Short Musculoskeletal Function Assessment and EuroQol-Visual Analogue Scale) on both day 0 (pre-trauma) and 1-year post-trauma were included. The difference in PROMs between day 0 and 1 year was calculated for each patient (delta value) and mean delta values were calculated at group level, based on the AO/OTA fracture classification.
Results: 11,733 patients with 11,751 fractures with complete PROMs were included. According to the AO/OTA classification, 21% were A fractures, 67% were B fractures and 12% were C fractures. All groups of patients, regardless of fracture class (A1–C3), displayed an impairment in PROMs after 1 year compared with day 0. Type C fractures displayed a larger impairment in PROMs at group level than type B, which in turn had a greater impairment than type A. The same pattern was seen in groups 3, 2, and 1 for A and B fractures.
Conclusion: We found that the AO/OTA classification is prognostic, where more complex fractures were associated with poorer PROMs.
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Bergh C, Wennergren D, Möller M, Brisby H. Fracture incidence in adults in relation to age and gender: a study of 27,169 fractures in the Swedish Fracture Register in a well-defined catchment area. PLoS One 2020; 15(12): e0244291. doi: 10.1371/journal.pone.0244291. DOI: https://doi.org/10.1371/journal.pone.0244291
Juto H, Nilsson H, Morberg P. Epidemiology of adult ankle fractures: 1756 cases identified in Norrbotten County during 2009–2013 and classified according to AO/OTA. BMC Musculoskelet Disord 2018; 19(1): 441. doi: 10.1186/s12891-018-2326-x. DOI: https://doi.org/10.1186/s12891-018-2326-x
Thur C K, Edgren G, Jansson K, Wretenberg P. Epidemiology of adult ankle fractures in Sweden between 1987 and 2004: a population-based study of 91,410 Swedish inpatients. Acta Orthop 2012; 83(3): 276-81. doi: 10.3109/17453674.2012.672091. DOI: https://doi.org/10.3109/17453674.2012.672091
Elsoe R, Ostgaard S E, Larsen P. Population-based epidemiology of 9767 ankle fractures. Foot Ankle Surg 2018; 24(1): 34-9. doi: 10.1016/j.fas.2016.11.002. DOI: https://doi.org/10.1016/j.fas.2016.11.002
Nilsson G, Jonsson K, Ekdahl C, Eneroth M. Outcome and quality of life after surgically treated ankle fractures in patients 65 years or older. BMC Musculoskelet Disord 2007; 8: 127. doi: 10.1186/1471-2474-8-127. DOI: https://doi.org/10.1186/1471-2474-8-127
Chong H H, Hau M Y T, Mishra P, Rai P, Mangwani J. Patient outcomes following ankle fracture fixation. Foot Ankle Int 2021; 42(9): 1162-70. doi: 10.1177/10711007211003073. DOI: https://doi.org/10.1177/10711007211003073
Chan O, Lee C, Titheradge R, Auld F, Iliopoulos E. Patient reported outcomes following non-operatively managed Weber Type A distal fibula fractures. Foot Ankle Surg 2021. doi: 10.1016/j.fas.2021.01.013. DOI: https://doi.org/10.1016/j.fas.2021.01.013
Wennergren D, Ekholm C, Sandelin A, Möller M. The Swedish fracture register: 103,000 fractures registered. BMC Musculoskelet Disord 2015; 16: 338. doi: 10.1186/s12891-015-0795-8. DOI: https://doi.org/10.1186/s12891-015-0795-8
Möller M, Wolf O, Bergdahl C, Mukka S, Rydberg E M, Hailer N P, et al. The Swedish Fracture Register: ten years of experience and 600,000 fractures collected in a National Quality Register. BMC Musculoskelet Disord 2022; 23(1): 141. doi: 10.1186/s12891-022-05062-w. DOI: https://doi.org/10.1186/s12891-022-05062-w
Juto H, Möller M, Wennergren D, Edin K, Apelqvist I, Morberg P. Substantial accuracy of fracture classification in the Swedish Fracture Register: evaluation of AO/OTA-classification in 152 ankle fractures. Injury 2016; 47(11): 2579-83. doi: 10.1016/j.injury.2016.05.028. DOI: https://doi.org/10.1016/j.injury.2016.05.028
Swiontkowski M F, Engelberg R, Martin D P, Agel J. Short musculoskeletal function assessment questionnaire: validity, reliability, and responsiveness. J Bone Joint Surg Am 1999; 81(9): 1245-60. doi: 10.2106/00004623-199909000-00006. DOI: https://doi.org/10.2106/00004623-199909000-00006
Bouffard J, Bertrand-Charette M, Roy J S. Psychometric properties of the Musculoskeletal Function Assessment and the Short Musculoskeletal Function Assessment: a systematic review. Clin Rehabil 2016; 30(4): 393-409. doi: 10.1177/0269215515579286. DOI: https://doi.org/10.1177/0269215515579286
de Graaf M W, Reininga I H, Wendt K W, Heineman E, El Moumni M. The Short Musculoskeletal Function Assessment: a study of the reliability, construct validity and responsiveness in patients sustaining trauma. Clin Rehabil 2019; 33(5): 923-35. doi: 10.1177/0269215519828152. DOI: https://doi.org/10.1177/0269215519828152
Rabin R, de Charro F. EQ-5D: a measure of health status from the EuroQol Group. Ann Med 2001; 33(5): 337-43. doi: 10.3109/07853890109002087. DOI: https://doi.org/10.3109/07853890109002087
Offentlighets- och sekretesslag (2009: 400). Chapter 21 paragraph 7, chapter 25 paragraph 1 2009 [cited 2022 10 November]. Available from: https://www.riksdagen.se/sv/dokument-lagar/dokument/svensk-forfattningssamling/offentlighets--och-sekretesslag-2009400_sfs-2009-400#totop.
Audet M A, Benedick A, Breslin M A, Schmidt T, Vallier H A. Determinants of functional outcome following ankle fracture. OTA Int 2021; 4(3): e139. doi: 10.1097/oi9.0000000000000139. DOI: https://doi.org/10.1097/OI9.0000000000000139
Gilley J, Bell R, Lima M, Butler B, Barrett J E, Patel M, et al. Prospective Patient Reported Outcomes (PRO) study assessing outcomes of surgically managed ankle fractures. Foot Ankle Int 2020; 41(2): 206-10. doi: 10.1177/1071100719891157. DOI: https://doi.org/10.1177/1071100719891157
Rydberg E M, Wennergren D, Stigevall C, Ekelund J, Möller M. Epidemiology of more than 50,000 ankle fractures in the Swedish Fracture Register during a period of 10 years. J Orthop Surg Res 2023; 18(1). doi: 10.1186/s13018-023-03558-2. DOI: https://doi.org/10.1186/s13018-023-03558-2
McCreary D L, Cunningham B P. Minimum Clinically important difference in Short Musculoskeletal Function Assessment: what change matters in ankle fractures. Foot Ankle Spec 2021; 14(6): 496-500. doi: 10.1177/1938640020923262. DOI: https://doi.org/10.1177/1938640020923262
Juto H, Gartner Nilsson M, Möller M, Wennergren D, Morberg P. Evaluating non-responders of a survey in the Swedish fracture register: no indication of different functional result. BMC Musculoskelet Disord 2017; 18(1): 278. doi: 10.1186/s12891-017-1634-x. DOI: https://doi.org/10.1186/s12891-017-1634-x
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