Treatment and rehabilitation of ankle fractures in patients with chronic venous insufficiency

Background. Danis-Weber type C ankle fractures are considered particularly severe and usually necessitate surgical intervention to restore joint function. However, for patients with accompanying vascular pathologies, standard osteosynthesis methods cannot be used. The purpose was to improve integrated surgical and rehabilitation approaches for Danis-Weber type C ankle fractures in patients with concomitant chronic venous insufficiency (CVI). Materials and methods. The study cohort comprised 23 middle-aged patients presenting with Danis-Weber type C ankle fractures. Group I (study group) consisted of 6 patients with concomitant CVI who underwent minimally invasive osteosynthesis. Group II (comparison one) included 7 patients without CVI who received the same osteosynthesis technique. Group III (control group) comprised 10 patients without CVI who underwent osteosynthesis by plating. All patients received standard thromboprophylaxis according to the Caprini score. Functional recovery was evaluated with the Olerud-Molander Ankle Score (OMAS). Results. Radiographic analysis demonstrated that the anatomical integrity of the ankle joint was successfully restored to normal reference values in all study groups. Quantitative parameters, including tibiofibular overlap, tibiofibular clear space, and medial clear space, dime/ball sign confirmed accurate reduction and alignment without significant deviations from normative values. Comparative assessment showed no statistically significant intergroup differences in the restoration of these anatomical indices, indicating uniform surgical efficacy across the examined cohorts. Regarding rehabilitation outcomes, the median OMAS scores indicated satisfactory ankle function restoration across all groups. Patients experienced similar improvements in mobility, pain relief, and daily activity performance. Statistical analysis revealed no significant differences in functional outcomes among the groups. Conclusions. The most appropriate osteosynthesis technique for patients with concomitant CVI should be based on a comprehensive, multidisciplinary evaluation that fully accounts for the complexity of both the vascular and orthopaedic considerations. Preference ought to be given to minimally invasive approaches, accompanied by the implementation of adequate thromboprophylactic measures to mitigate perioperative risks.