Functional outcomes following open reduction and internal fixation of closed bimalleolar ankle fractures: a prospective cohort study from a tertiary care centre in South India

Background: Bimalleolar ankle fractures are unstable injuries that can cause persistent pain, restricted motion, gait disturbance, instability, and post-traumatic osteoarthritis if anatomical alignment is not restored. Open reduction and internal fixation (ORIF) is widely used for unstable ankle fractures, but prospective outcome data from Indian tertiary care centres remain limited. Objective was to evaluate functional outcomes after ORIF of closed bimalleolar ankle fractures using the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score over 12 months. Methods: A prospective observational cohort study was conducted between April 2024 and March 2026 at Siddhartha Medical College and Government General Hospital, Vijayawada, India. Thirty adult patients with closed bimalleolar ankle fractures underwent ORIF according to standard AO fixation principles. Functional outcomes were assessed at 6 weeks, 12 weeks, 6 months, 9 months, and 12 months using the AOFAS ankle-hindfoot score. Demographic characteristics, pain, walking ability, gait, ankle motion, stability, alignment, radiographic findings, and postoperative complications were assessed. Results: All 30 patients completed the 12-month follow-up. The mean age was 45.4±8.98 years, 60% were male, and road traffic accidents accounted for 66.7% of injuries. Pain, walking ability, gait, ankle motion, and functional scores improved progressively. At one year, 24 patients (80%) had excellent AOFAS outcomes, four (13.3%) had good outcomes, and two (6.7%) had fair outcomes; no patient had a poor outcome. Overall, 93.3% achieved good-to-excellent functional results. Conclusions: ORIF was associated with progressive functional recovery over 12 months in this cohort of closed bimalleolar ankle fractures. Anatomical reduction, stable fixation, and structured rehabilitation were associated with favourable restoration of pain, mobility, gait, stability, and overall ankle function.