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Ankle fractures are one of the most common operatively treated lower extremity fractures. Several studies indicate that patients often have residual effects after this injury. The purpose of this study is to use the SF-36 questionnaire at two times to assess patients' functional recovery and residual effects after operative stabilization of an unstable ankle fracture.Twenty adult patients with an isolated unstable ankle fracture (OTA 44B/C) who had operative stabilization completed an SF-36 questionnaire when they were released from orthopaedic follow-up at approximately four months from injury. These same patients again completed the SF-36 at a longer follow-up, twenty months on average. Both SF-36 scores were compared with U.S. population norms.Level II Community Hospital.Internal fixation of unstable ankle fractures.SF-36 questionnaire.Patients had significant improvement (p < 0.5) in all domains of the SF-36 questionnaire at the later follow-up, except for general health, which was unchanged. Patients still had significant differences in SF-36 scores compared with the U.S. population at the time of release from routine follow-up. The scores of all the domains of the SF-36 at the later follow-up were not significantly different from U.S. population norms except for the domain of physical functioning.This study indicates that patients have significant improvement in functional outcome after release from orthopaedic follow-up but have a residual physical effect at twenty months after injury. These data are important to guide a patient's expectations after this injury and are also important in considering medicolegal and workers' compensation issues. Patients continue to have improvement in function after we have routinely released them from orthopaedic follow-up. Maximal medical improvement appears to be longer than four months from this injury.