Return to Duty Following Open Reduction and Internal Fixation of Unstable Ankle Fractures in the Active Duty Population.

Introduction: Literature on functional outcomes after ankle surgery is for the most part limited to return to sport studies. The purpose of this study was to determine occupational and functional outcomes following operative treatment of unstable ankle fractures in the active duty military population.

Materials and Methods: All ankle fractures treated with open reduction internal fixation at a single institution from 2013 to 2015 were reviewed. Inclusion criteria included active duty personnel with a single-sided injury requiring operative management. All patients had a minimum of 6 months follow-up. Forty-seven records were reviewed with 43 patients fitting these criteria. Patients were predominantly male (91%) with an average age of 26 years at the time of fracture. Functional outcomes were evaluated using AOFAS and SANE scores. Occupational outcomes were determined in reference to a service member's ability to return to full duty.

Results: Of the 43 subjects, 81% (n = 35) returned to active duty. Of the eight individuals who did not return to active duty, six were medically boarded out of the military. Looking at demographic, surgical, and functional variables, only the SANE and AFAOS scores functional outcomes showed a significant correlation with individual return to duty. Individuals who reported less pain and increased functional outcomes had increased return to duty rates.

Conclusion: This study sought to determine predictors for return to duty within an active duty military population after ORIF of unstable ankle fractures. Given the paucity of military literature on this subject, the end goal was to provide realistic recovery expectations for both injured service members and their command teams. Overall, 81% of patients were able to return to active duty following operative treatment of unstable ankle fractures. There were no associations found between age, gender, military rank, or fracture patterns and return to duty.