الفهرس 
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Abstract
A
nkle fractures are very frequent and they can present a variety of clinical features. Dislocated or unstable ankle fractures are generally treated with surgical anatomical reduction and internal fixation. Most of these fractures heal very well. However, some of these fractures fail to reduce and become malunited.
Early biomechanical studies have demonstrated that lateral talar shift greater than 1mm may cause a loss of over 40% of the tibiotalar contact area.
Malunited ankle fracture predisposes individuals to develop chronic pain, functional impairment, and post-traumatic ankle arthritis. There is high association between malunited ankle fractures and poor outcomes that may require revision surgeries.
The literature supports reconstructive or revision surgery even in the setting of degenerative changes whatever the time interval.
However, early timing of surgical intervention is advised to minimize perioperative soft tissue compromise, postoperative risks of infection and soft tissue complications and decrease progression of joint arthritis.
The aim of the treatment is to obtain an ankle with normal alignment and function which exhibits no pain with preventing any degenerative changes that may take place in the future. Surgical options include refixation of non-united medial or lateral malleolus, lengthening of fibula, repair of neglected syndesmotic injury, and repair of other ligamentous injury.
Our study included 30 patients with malunited ankle fractures. The outcomes were compared pre and post operatively. The Inclusion criteria were patients with malunited or neglected ankle fractures, both sexes and Age between 20 – 60 years old. While, Exclusion criteria were patients suffering from peripheral vascular insufficiency, advanced ischemia, peripheral neuropathy, advanced tibiotalar osteoarthritis, soft tissue compromise, stiff ankle, infected non-union and skeletally immature patients.
The outcome was assessed clinically by patient satisfaction, ankle range of motion, AOFAS score, FAAM score and FADI score. Radiologically the outcome was assessed by comparing pre and post-operative medial clear space and tibiofibular overlap.
The patient satisfaction was evaluated pre and post operatively were 46.7% were excellent, 36.7% were good, 13.3% were fair and 3.3% were poor.
The global ankle range of motion among patients with syndesmotic affection showed improvement from preoperative mean±SD 33.82±9.61 to 60±8.66 post operatively while in patient with non syndesmotic affection the improvement was 41.54±13.29 preoperatively to 61.15±12.61 postoperatively. This means that there is increase in global ankle motion but the improvement was higher in patients with syndesmotic affection.
The AOFAS in patient with syndesmotic affection showed improvement from mean±SD 48.35±12.99 preoperatively to 82.71±10.32 postoperatively, while in patients with non syndesmotic affection showed improvement from 60.46±18.91 preoperatively to 86.77±20.79 post operatively. This means that this is significant increase in AOFAS score in both groups but its more obvious among patients with syndesmotic affection.
The FAAM score in patient with syndesmotic affection showed improvement from mean±SD 46.47±15.96 preoperatively to 82.41±8.05 postoperatively, while in patients with non syndesmotic affection showed improvement from 54±18.96 preoperatively to 79.77±16.45 post operatively. It means that there is increase in FAAM score in both groups but its more significant among patients with syndesmotic affection.
The FADI score among patients was mean±SD 49.87±11.39 preoperatively and 77.07±11.89 two years postoperative, there was statistically significant higher mean value of FADI in follow up compared to pre-operative.
Radiologically the patients were compared by the measurement of tibiofibular overlap, in patients with syndesmotic affection pre-operative and two years post-operative showing increase in mean value from mean±SD 7.06±1.85 pre-operative to 12.06±1.64 post-operative which means significant improvement.
Follow up with measurement of medial clear space in patients with syndesmotic affection pre-operative and two years post-operative showing increase in mean value from mean±SD 4,65±1.46 pre-operative to 3,12±0.86 post-operative with significant improvement.
There is statistically significant improvement in functional and radiological outcomes in patients with syndesmotic affections more than patients with non syndesmotic affection.