The effect of concomitant chondral injuries accompanying operatively reduced malleolar fractures.

The best clinical results in the treatment of malleolar fractures occur when an anatomic reduction is obtained and maintained until the fractures are healed. Ankle pain and/or tibio-talar arthrosis has been reported despite anatomic surgical reduction and stable fixation of the malleoli. This may be due to unrecognized injuries to the cartilaginous surfaces of the tibio-talar joint. Between 1984 and 1987, 63 patients with isolated closed malleolar fractures underwent open reduction and internal fixation using standard AO techniques. Each patient had inspection of the entire talar dome during surgery. There were seven type A, 37 type B, and 19 type C fractures. Thirty-one patients (49%) had injuries to the talar dome cartilage, ranging from mild scuffing to free osteochondral fragments. Twenty-five patients were available for a follow-up evaluation at an average of 25 months after surgery. Thirteen patients had some complaints of pain, eight of whom had talar dome chondral injuries. The overall results, including functional status and ankle range of motion, were significantly poorer in patients with talar dome chondral injuries (p less than or equal to 0.03 and p less than or equal to 0.042, respectively).