1. THE PATTERN OF ANKLE FRACTURES IN KENYATTA NATIONAL HOSPITAL Presenter Dr Mustafa Other authors professor Mulimba, Dr E. Oburu

2. introduction Ankle fractures are among the most common injuries treated by orthopeadic surgeons. Ankle fracture are usually as a result of low energy and rotational forces(twisting mechanism)(1,2). Incidence of these fracture is on the rise, higher rates in Africa due to road carnage(4)

3. Kenyatta National Hospital deals with ankle fracture on daily basis. This injury leads to loss of productive man hours of patients making them unproductive. This study looked at pattern of ankle fractures seen at Kenyatta National hospital and treatment modalities used for these fractures.

4. methodology All patients with ankle fractures above 18 years were included in the study and exclusion criteria included pediatric patients, patient with ankle fractures for more then 3 months, and ipisilateral limb fractures. Study conducted after ethical approval from KNH/UON ethical committee.

5. A total of 100 patients were recruited case based as they presented to KNH Patients biodata and information regarding the fracture obtained through a questionaire Treatment modality indicated at first contact and review of the patient at 6 and 12 weeks with radiographs done.

6. results This study collected data from 100 participants. The mean age is of 40 years with a range of 20 years to 80 years. The sample had 70 male cases,and 30female cases A majority of the cases did not smoke. Alcohol consumption was evenly distributed amongst the participants. Five of the participants had diabetes mellitus.

7. Most common age group being 36-50 years and also 20-35years with both groups having male preponderence. Most of the fractures resulted from motorcycle accident. These accounted for 34.00% (n= 34) of the fractures. Assault accounted for the least number of fractures with a proportion of 2.0% (n=2)

8. B2 was found to be the most common type accounting for 35% with C3 being the least common type of fracture according to AO weber classification. Non-operative modality of treatment was the most commonly used with a proportion of 68% (n=68) while operative cases had a proportion of 28% (n= 28). Two patients presented late and required operative treatment but was not done due to finances, while two patientswere lost to follow up during analysis

9. Fractures beyond b2 had higher complication rates treated non operatively.

10. discussion 100 patients in 6 months accounted to 6 patients in week which is a significant burden. This study showed male preponderance with peak incidence of third decade of life while female in the third and fifth decade.(14,29) Fall from same level dominating mechanism in other studies, this study had higher motorcycle related accidents being as high as 34% (9,15,62)

11. AO weber B2 type being higher which was consistent with other studies.(9,27,30) The study showed higher rates of complication with type B and C treated non operatively consistent with other studies which have suggested TypeB and C to be unstable fractures managed operatively(34,63)

12. LIMITATIONS 1.Risk factors was assessed clinically using patient’s history and no special test was done to evaluate the risk factors. 2.Follow up was short because of student time constriants 3.Inadequate funds.

13. CONCLUSIONS In conclusion the study showed high rate of fractures due to motorcycle accidents. Majority were males in their twenties and older women. Type B being the commonest type of ankle fractures. Non operative treatment was the commonest mode of treatment offered even for fractures which needed operations the lead to higher complication rates among the mode of treatment offered.

14. RECOMMENDATIONS There is need for good road safety measures concerning especially motorcycle to reduce the trauma burden as most of the fractures were due to accidents. There is need for a protocol to be developed to ensure appropriate management of ankle fractures. This will reduce the number of fractures inappropriately managed. There is need for a larger, longer and multicentre study of ankle fracture management to make more appropriate recommendations. Quantitative study for risk factors is proposed as there is a positive correlation with risk factors and fracture also subsequent healing.

15. Thank you questions