[Related factors and analysis of prevention strategies for functional ankle instability after ankle fracture surgery].

OBJECTIVE

To explore related factors and preventive strategies of functional ankle instability (FAI) in patients with ankle fracture (AF) after surgery.

METHODS

Clinical data of 348 patients with atrial fibrillation (AF) who underwent surgical treatment from January 2022 to September 2023 were retrospective analyzed, including 143 males and 205 females;aged 65 years or above for 150 patients, and younger than 65 years old for 198 patients;body mass index(BMI) of≥24 kg·m-2 for 217 patients, and BMI<kg·m-2 for 131 patients. All patients were divided into unstable group(71 patients) and stable group (277 patients) based on whether FAI occurred at 1 year after operation. The occurrence of FAI was statistically analyzed;gender, age, BMI, injury cause, smoking history, drinking history, hypertension, diabetes, posterior malleolus fracture Haraguchi classification, the time from injury to operation, proportion of fracture fragments on joint surface, combined ankle dislocation, deltoid ligament injury, surgical method, postoperative complications, whether there was nerve injury during operation, whether calcaneal traction was performed, and the start time of rehabilitation between two groups were compared. Using multivariate Logistic regression analysis was identified the risk factors for the occurrence of FAI after AF.

RESULTS

A total of 348 patients who underwent AF were followed up for 1 year after operation. Among them, 71 patients developed FAI, with an incidence rate of 20.40%. The proportions of patients in unstable group who were≥65 years old, Haraguchi typeⅡposterior malleolus fractures, a post-injury to surgery time of≥8 h, fracture block occupying ≥25% of joint surface, had combined ankle dislocation, treated with tension screws, had infection or incision dehiscence, and start-to-rehabilitation time of ≥7 days were all higher than those in stable group, and the differences were statistically significant (P<0.05). Multivariate Logistic regression analysis showed age above 65 years old [OR=2.221, 95%CI(1.207, 4.086), P=0.010], posterior malleolar fracture Haraguchi classification typeⅡ[OR=2.664, 95%CI (1.718, 4.133), P<0.001], fracture block occupying≥25% of joint surface [OR=1.902, 95%CI(1.241, 2.916), P=0.003], combined with ankle joint dislocation [OR=2.385, 95%CI(1.330, 4.276), P=0.004], and the start of rehabilitation time≥7 days [OR=1.972, 95% CI(1.296, 2.999), P=0.002] were independent risk factors for FAI after AF (P<0.05).

CONCLUSION

Age above 65 years old, Haraguchi classification of posterior malleolar fracture for typeⅡ, fracture fragment occupying≥25% of the joint surface, combined with ankle joint dislocation, and the start of rehabilitation time being≥7 days are independent risk factors for FAI after AF. To reduce the occurrence of postoperative FAI, clinical measures could be taken based on these factors to intervene in high-risk patients.