Pattern and outcome of bimalleolar fractures at Kenyatta National Hospital.

Abstract

Background: Ankle fractures account for 10% of all fractures. Their incidence is projected to triple over the next 15 years according to Finnish statistics. Bimalleolar fractures constitute 25% of all ankle fractures where on an average basis 38 patients with bimalleolar fractures are treated at KNH every month. Bimalleolar fractures may be managed either operatively or non-operatively. There is scarcity of data on the pattern and outcome of bimalleolar fractures in Kenya. Objective: This study aimed at determining the pattern and outcome of bimalleolar ankle fractures at Kenyatta National Hospital, the largest referral hospital in Kenya Patients and methods: A prospective observational study of 72 patients with bimalleolar ankle fractures was carried out after institutional approval. Patients who had bimalleolar ankle fractures and presented between August 2015 and November 2015 were included and followed up for 12 weeks. The AOFAS and VAS were used to assess short term outcomes as at 12 weeks. The main outcome measures were pain, functional capacity and alignment. Results: The patients’ age ranged from 19 to 63 mean 36.4 ±10.4 years. The male to female ratio was 3:2. Falls caused 50% of the fractures, motor vehicle accidents 36.1% and motor cycle accidents 13.9%. Closed fractures accounted for 63.9% of the cases. The most common fractures based on the Weber classification were B and C which occurred in 33 (45.8%) and 31 (43.1%) patients, respectively At 3 months, the mean AOFAS was 78.2. The VAS between 1 and 3 was 43.1%. Twenty eight patients (38.8%) had no pain. There was no difference in AOFAS and VAS between operative and non operative, open or closed Weber B fracture outcomes. The Weber C fractures managed operatively had a significantly lower 2 AOFAS, 63 compared to non-operative cases who scored 84.3. Medial clear space greater than 4mm was associated with a poor outcome. Conclusion: Patients presenting in KNH with bimalleolar fractures are young. Delay in definitive treatment of up to a week post-fracture does not seem to adversely affect the. The main determinant of good outcome was the medial clear space that was less than 4mm.