A prospective study of Functional Outcome Comparison Between Bimalleolar and Trimalleolar Ankle Fractures Treated Surgically

Abstract Background: Ankle fractures, particularly bimalleolar and trimalleolar types, are common orthopedic injuries requiring surgical intervention. Understanding their functional outcomes is critical for optimizing treatment strategies.Objective: To compare the functional outcomes, pain, range of motion (ROM), and complications in patients with surgically treated bimalleolar and trimalleolar ankle fractures. Methods: A prospective study was conducted at Al-Ameen Medical College and Hospital, involving 35 patients (20 bimalleolar, 15 trimalleolar) aged 20–60 years who underwent open reduction and internal fixation (ORIF). Outcomes were assessed using the Olerud and Molander Ankle Score (OMAS), American Orthopaedic Foot & Ankle Society (AOFAS) score, and Foot and Ankle Disability Index (FADI) at 6 weeks, 3 months, and 6 months post-surgery. Complications and ROM were also evaluated. Results: Bimalleolar fractures demonstrated higher mean OMAS (89.2 ± 6.5 vs. 85.1 ± 7.3, p=0.134) and AOFAS scores (91.6 ± 5.2 vs. 87.9 ± 6.1, p=0.112) at 6 months compared to trimalleolar fractures. Bimalleolar patients achieved earlier weight-bearing (8.2 ± 1.4 weeks vs. 9.3 ± 1.6 weeks, p=0.029) and better ROM (dorsiflexion: 15.2° ± 3.1 vs. 12.4° ± 2.9, p=0.046; plantarflexion: 38.6° ± 4.5 vs. 35.8° ± 3.7, p=0.048). Trimalleolar fractures had a higher complication rate (75% vs. 25%). Conclusion: Bimalleolar fractures showed better functional outcomes and faster recovery compared to trimalleolar fractures, though both achieved satisfactory results with proper surgical management and rehabilitation.