Functional and Radiological Outcomes of Closed Ankle Fractures Managed Non-Operatively Among Adults at Mulago National Referral Hospital Six Months Post-Injury: A Cross-Sectional Study

Abstract : Background: Non-operative management is a common approach for treating closed ankle fractures at Mulago National Referral Hospital (MNRH) due to its potential benefits, including shorter hospital stays and the absence of surgical risks. Evaluating functional and radiological outcomes is essential for determining the success of this treatment. This study aimed to evaluate the functional and radiological outcomes of ankle fractures managed non-operatively and to identify the factors associated with these outcomes. Methods: This cross-sectional study assessed 93 adults with ankle fractures managed non-operatively at six months post-injury at Mulago National Referral Hospital. Functional outcomes were evaluated using the AOFAS ankle-hindfoot score, while radiological outcomes included fracture union and ankle alignment parameters. Data were analyzed using STATA, and modified Poisson regression was applied to identify factors associated with functional and radiological outcomes. Results: The mean age and standard deviation were 41+/-12 years. More females, n=49(52.7%), had ankle fractures. The commonest fracture type was Weber B n=65(69.9%)> Weber C n=16(17.2%)> Weber A n=12 (12.9%). The mean AOFAS-AH score was 82.9 ± 14.9. Patients had an AOFAS-AH score categorized as good (54.8%)>excellent (23.7%)>fair (16.1%)>poor (5.4%). Eight-six (92.5%) had radiological union, and 7(7.5%) had nonunion. 97.7% of the patients had a normal MCS, 80.2% normal TFO, 50% normal TCA, and 13.9% normal TFCS. Significant predictors of poor functional outcomes included being HIV-positive, Weber B fractures, and Weber C fractures. Predictors of good functional outcomes included receiving physiotherapy and initiating weight bearing at 4-6 weeks or after 6 weeks Conclusion: The majority of participants achieved radiological union, though all united fractures resulted in malunion. Worse functional outcomes were associated with Weber classifications B and C, as well as HIV-positive status.