Ankle fracture is associated with prolonged venous dysfunction

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Abstract
Leg swelling is a significant problem following ankle fracture. Venous pump function and femoral and popliteal venous patency were assessed prospectively in 26 patients with ankle fractures requiring open reduction, internal fixation and immobilization in plaster. Functional venous volume, venous filling index (VFI), ejection volume fraction (EVF) and residual volume fraction (RVF) were measured using air plethysmography at 5 days and at 6, 12 and 18 weeks after fracture. The uninjured leg was used as a control. Popliteal and femoral venous patency was determined using duplex ultrasonography. No patient developed deep vein thrombosis during the study. At 5 days after fracture there was a significant reduction in mean(s.d) EVF, 18·2(12·1) versus 55·9(19·5) percent, and increase in RVF, 87·0(14·3) versus 42·5(22·2) per cent (both P < 0·001). Analogous values were similar at 6 weeks, EVF 28·5(21·2) versus 55·6(21·9) per cent, RVF 82·2(16·8) versus 48·5(23·8) per cent (both P < 0·001), and at 12 weeks, EVF 39·1(16·0) versus 60·3(14·9) per cent, RVF 64·7(18·8) versus 38·8(13·2), per cent (both P < 0·001). However, by 18 weeks there was no significant difference in venous function between fractured and control limbs. It is concluded that there is a significant and prolonged impairment in venous pump function following ankle fracture.