Bone mineral density is a valuable clinical tool to diagnose osteoporosis. Another property is the 'bone quality' which helps the bone to resist fracture and may contribute to determining fracture rates postoperatively. This study helps to elucidate the bone quality effects on fracture rates after the treatment.

Osteoporosis and reduced bone density are associated with high fracture rate and severity. The impact of bone density on fracture rate and related treatments are well known, but how the quality of bone influences the clinical results after fracture fixation is still unexplored. This study aimed to find this association.

The patients were selected from the database involved treatment of ankle fractures by a surgeon between 2003 to 2013. Computed tomography (CT) imaging of injured and contralateral ankle pre- and post-operatively was carried out in all patients. An elliptical region of interest enclosed to the cancellous metaphyseal part of the distal fibula and tibia to estimate Hounsfield unit (HU) measurement values. Ankle range of motion (ROM) and Foot and Ankle Outcome Scores (FAOS) were taken as the outcomes of the study. Patients comprised approximately one year of clinical outcome data.

A total of sixty-four patients matched the inclusion criteria. The HU values can be precisely estimated in the context of a fracture as almost perfect agreement seen between the compared HU values of injured and contralateral sides. Enhance outcomes of four in the five FAOS domains (quality of life, activities of daily living, pain, and sports) shows a significant association with elevated HU values of the injured distal fibula and tibia (P ≤ 0.05 for all). However, no association was noticed between HU values and range of motion outcomes.

CT detected decreased bone quality preoperatively shows a significant relationship with the lower short-term clinical outcomes. These findings suggest combining bone quality into treatment algorithms for fracture patients.