Comparison of clinical outcome, cost and union times in pediatric ankle fractures

Aims: The aim of this study was to evaluate the effects of fracture type and implant used in ankle-related fractures in pediatric patients on functional outcome, union time, hospital stay and cost. Methods: A total of 58 cases operated on due to ankle fractures between 2017 and 2023 were reviewed. Patients were divided into 4 groups according to diagnosis. The first group included patients with isolated malleolus fractures, the second group included patients with bimalleolar or trimalleolar fractures, the third group included patients with distal tibia fractures, and the fourth group included patients with distal tibia fractures with a lateral malleolus. Patients were divided into five groups according to the implants used. These were determined as: K-wire, cannulated screw, plate screw, cannulated screw and plate screw, cannulated screw and plate screw+fixator. Demographic characteristics, union times, implant costs, and the American Orthopaedic Foot and Ankle Society (AOFAS) score were examined between the groups. Results: Union time was significantly shorter in patients with isolated malleolar fractures compared to other groups (p=0.042). Cost analysis by diagnosis showed that costs in the range of $100-300 were more common in isolated malleolar fractures, whereas costs exceeding $300 were more common in distal tibia fractures (p=0.001). Post-recovery AOFAS (American Orthopaedic Foot & Ankle Society) scores were significantly higher in the isolated malleolar fracture group compared to the bimalleolar/trimalleolar and distal tibia fracture groups (p=0.001). Comparison between all groups; implant comparison, the mean union time (in months) was significantly longer in the cannulated screw+plate and screw+fixator group compared to the K-wire, cannulated screw, plate and screw, and cannulated screw+plate and screw groups (p=0.0001). The plate and screw group also had significantly longer union times than the K-wire and cannulated screw groups (p=0.002, p=0.0001). Post-recovery AOFAS scores were significantly higher in the K-wire group compared to the plate and screw and cannulated screw+plate and screw+fixator groups (p=0.018). Conclusion: In isolated malleolar fractures, due to the more minor nature of the trauma, shorter hospital stays, quicker fracture union, better functional outcomes, and lower implant costs were observed. Implant costs did not affect functional outcomes or time to union.