How well do we reduce ankle fractures intra-operatively: A retrospective 1 year review using Pettrone's criteria

Introduction:
Ankle fractures are a common injury and considered to be part of the ‘bread & butter’ of orthopaedic trauma surgery. The management of these injuries forms part of the AO Principles course, which is mandatory for application for a specialty training number in trauma & orthopaedics. It has also been used for the technical skills assessment for the national selection process for England. The implication is that ankle fracture fixation is an easy procedure and well within the competencies of all trauma & orthopaedic surgeons.

Previous studies demonstrate that most cases of osteoarthritis of the ankle (78%) are post-traumatic in nature (1). Further analysis of this group of patients demonstrates that 48% of patients with post-traumatic ankle arthritis had malleolar fractures. This equates to 37.4% of all patients presenting with ankle arthritis having had a ‘simple’ ankle fracture in the past which as previously mentioned is assumed to be well within the competencies of orthopaedic surgeons to fix. (1)

Our study was inspired by an abstract from the BOFAS annual meeting proceedings from University Hospital Aintree (UHA) (2). Using Pettrone’s criteria, they found a 32.5% mal-reduction rate in their study group of ankle fractures, which required open reduction internal fixation. (2,3)