Does Pre-Injury Level of Activity Impact Post-Recovery Activity Level Regardless of Ankle Fracture Type?
Authors: Hadley Steven M. , Peabody John J. , Westvold Sarah , Bergman Rachel , Chang Shaun , Patel Milap , Kadakia Anish R. 
Published: December 2024

Category: Ankle; Trauma Introduction/Purpose: Studies have evaluated the impact of ankle fracture subtype and level of athletic competition on ability and time to return to sporting activity. Limited studies have analyzed whether pre-injury activity level influences return to activity for the general population. Our study investigates whether pre-injury activity level is associated with post-recovery activity level regardless of fracture subtype characterized by the Weber classification. We hypothesize that pre-injury activity level of patients will not be associated with post-recovery activity level regardless of fracture subtype among patients with fractures anatomically reduced during operative repair. This investigation is the largest retrospective cohort study evaluating the influence of pre-injury activity level on return to any activity for the general population. Methods: We retrospectively reviewed all 782 patients who underwent surgical repair of an ankle fracture at Northwestern Memorial Hospital from 2016-2021. Two foot and ankle fellowship trained orthopedic surgeons independently reviewed all radiographs. Patients were stratified by Weber fracture subtype, fixation technique, and reduction quality at final follow-up. Patients with multiple injuries at time of presentation, pilon variants, and who identified as part of vulnerable populations were excluded. Of the 703 patients included, 218 completed a post-operative questionnaire querying their activity level (sedentary, light, moderate, and high) before and after surgery and any current activity limitations. The 200 closed fractures were included for final analysis. 117 of the 200 patients had anatomic reduction of the ankle at minimum one year follow-up and reported no activity limitations due to fear of reinjury. Fisher’s exact test and Pearson’s chi-square test with Yates continuity correction were used for bivariate comparisons between groups. Results: 70% of patients reported returning to pre-injury activity level. Pre-injury activity level was significantly associated with return to activity (p=0.02). Across all groups, the highest proportion able to return to pre-injury activity level was those with sedentary/light activity (81.9%) and the lowest proportion was those with high activity (60.5%). When patients who experienced activity limitations due to fear of reinjury were excluded (N =159), no statistically significant association was found between pre-injury activity level and return to activity (p=0.1). Analysis of only those with anatomic reduction at minimum one-year follow-up who reported no fear of reinjury (N =117) found no significant association between pre-injury activity level and return to pre-injury activity level (p=0.1). Weber fracture subtype (N =200) was not associated with return to pre-injury activity level (p=0.16). Conclusion: Proper surgical fixation and anatomic reduction can return most patients of the general population back to pre-injury levels of activity regardless of pre-injury level of activity and fracture subtype. Patients who have lower activity demands can have higher expectations to return to their normal activity level compared to those who are more vigorously active. Fear of reinjury may influence patients’ abilities to return to activity, as when proper surgical fixation and reduction are achieved in patients with no fear of reinjury, pre-injury level of activity is no longer associated with ability to return to pre-injury activity level.