High fibula fracture with syndesmosis injury Short Musculoskeletal Functional Assessment (SMFA) and American Orthopaedic Foot and Ankle Society score (AOFAS) indicated delay in functional recovery with regards to age, female gender and presence of syndesmotic injury.Ĭase 1- Distal fibula fracture with deltoid ligament injury.Ĭase 2- Distal fibula fracture with deltoid ligament injury.Ĭase 1: Rush rodding of fibula and deltoid suturing.Ĭase 2: Suturing of deltoid plus cast immobilization.Ĭase 4: Syndesmosis fixation with 2 screws. Numbers in each category not specified other than 83 trimalleolar fractures Y(2 lateral malleolus, 3 medial malleolus, 27 bimalleolar, 12 trimalleolar) ORIF 20:-Lateral malleolus 13-Medial malleolus 7 Irrespective of treatment type:-Isolated distal fibula fracture 93.6 days-Combined injury 132.2 days Within isolated distal fibula fracture group:-ORIF- 117.1 days-Conservative- 72.1 days Total Cohort:-ORIF group 123.8 days-Conservative group 75.3 days. (100 in isolated distal fibula group and 28 in combined group.) The search strategy is displayed in Figure 1.Ĥ0 combined (distal fibula plus ankle dislocation or distal tibia fracture.) This included independent review of every abstract, review of every full text and reference list. Two authors (AS and GR) were involved in deciding which articles were included. Articles published in English, Italian, French and Spanish were included based on the linguistic ability of the authors. We excluded articles which assessed stress fractures of the ankle, cadaver studies, biomechanical studies, and single case reports. The reference lists of all articles identified in the electronic search were then hand searched to identify further relevant literature which may have been missed in the electronic search. 11Ī search was performed in January 2022 of the online databases Pubmed, Google Scholar, the Cochrane Library, EMBASE and CINAHL and Sports Discus using a combination of the following terms: ‘ankle fractures’, ‘ankle injuries’, ‘athletes’, ‘sports’, ‘return to sport’, ‘return to activity’, ‘operative management’, ‘non-operative management’. The study was performed adhering to the PRISMA guidelines (preferred reporting items in systematic reviews and meta-analysis). Predictive factors such as fracture pattern, age and gender that may have an effect on the return to sporting activity will also be assessed. The outcome measures of interest are the rate of return to sport, the time taken to return to sport and the level of sporting activity achieved post-treatment. The present systematic review focuses exclusively on acute traumatic sport-related ankle fractures, and reviews the outcomes of both operative and non-operative management. The present updated systematic review provides a contemporary assessment of the literature on the return to sports following acute ankle fractures. 10 That review only included operatively-managed ankle fractures, and assessed the outcome of both acute and stress fractures. Only one previous systematic review, published in 2013, assessed return to sport after ankle fractures. 7 However, non-operative management can be used successfully for ‘stable’, undisplaced ankle fractures in athletic patients. 5 Open reduction and internal fixation, as a treatment option for the management of ankle fractures, 6 especially for athletes, may allow earlier mobilization and hence a quicker return to sports. 4 Return to sport is an important goal in treatment of ankle fractures in a sporting population. 1–3 Acute traumatic ankle fractures account for between 7% and9% of all acute sport-related fractures. Ankle injuries can occur in both competitive and recreational athletes, with a reported prevalence of 15–25% of all sports injuries.
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