Table 1.
Study findings
| Author | Number fractures | Fracture type | Treatment | % return to sport | Time to return to sport | Patient reported outcome measure |
|---|---|---|---|---|---|---|
| Werner et al.13 | 237 | 197 isolated distal fibula. 40 combined (distal fibula plus ankle dislocation or distal tibia fracture.) |
ORIF 128 cases. (100 in isolated distal fibula group and 28 in combined group.) Conservative 109 cases. |
90% | Total Cohort:—ORIF group 123.8 days—Conservative group 75.3 days. Within isolated distal fibula fracture group:—ORIF- 117.1 days—Conservative- 72.1 days Irrespective of treatment type:—Isolated distal fibula fracture 93.6 days—Combined injury 132.2 days |
Unreported |
| Brent Lievers et al.14 | 49 | 28 isolated lateral malleolus 21isolated medial malleolus |
ORIF 20:—Lateral malleolus 13—Medial malleolus 7 Conservative: 28 |
100% | Lateral malleolus: 65 days Medial malleolus: 38 days |
Unreported |
| Chiet Hong et al.15 | 31 | 31 trimalleolar fractures. Subdivided into: 23 Weber B 8 Weber C |
ORIF 31 cases | 75% | Unreported | Olerud and Molander score. Overall mean score 78.3 at 1 year. Posterior malleolus fixed: 78.7 Posterior malleolus not fixed: 77.3 Weber B: 83.9 Weber C: 67.1 |
| Orr et al.16 | 72 | Isolated lateral malleolus: 45 Isolated medial malleolus: 11 Bimalleolar: 14 Trimalleolar: 2 |
ORIF 72 cases | 64% | Unreported | Unreported |
| Robertson et al.17 | 96 | Isolated lateral malleolus: 45 Isolated medial malleolus: 5 Bimalleolar: 34 Trimalleolar: 12 |
52 cases non-operativel Y(43 lateral malleolus, 2 medial malleolus, 7 bimalleolar). 44 operativel Y(2 lateral malleolus, 3 medial malleolus, 27 bimalleolar, 12 trimalleolar) |
94% overall. 100% non-operative group 87% operative group |
26 weeks Non-operative group: 20 weeks Operative group: 35 weeks Syndesmotic injury: 43 weeks Non-syndesmotic injury:25 weeks |
Unreported |
| Chiet Hong et al.18 | 47 | Bimalleolar: 26 Trimalleolar: 21 |
ORIF: 47 cases | 81.8% 27.3% to pre-injury level |
Unreported | Mean Olerud and Molander score 82.1. Bimalleolar: 81.7 Trimalleolar: 78.3 VAS Bimalleolar: 1.8 VAS Trimalleolar: 2 |
| Colvin et al.5 | 243 | Numbers in each category not specified other than 83 trimalleolar fractures | ORIF 243 | 25% overall 88% recreational athletes. 12% competitive athletes |
Unreported | 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. |
| Porter et al.19 | 27 | Bimalleolar: 10 Isolated lateral malleolus: 6 Salter-Harris Type: 4 Isolated medial malleolus: 2 Pilon: 1 |
ORIF 27 cases | 96% One case of non-return. |
Isolated lateral malleolus: 6.8 weeks. Isolated medial malleolus: 17.0 weeks |
AAOS Lower Limb Core Modules 94.6 for function 98.0 for pain |
| Mai et al.20 | 42 | Subtypes not reported. | ORIF: 42 cases. | 78.6% | Unreported | Unreported |
| Walsh et al.21 | 4 | Case 1- Distal fibula fracture with deltoid ligament injury. Case 2- Distal fibula fracture with deltoid ligament injury. Case 3- Trimalleolar ankle fracture. Case 4- Syndesmosis injury |
Case 1: Rush rodding of fibula and deltoid suturing. Case 2: Suturing of deltoid plus cast immobilization. Case 3: ORIF Case 4: Syndesmosis fixation with 2 screws. |
100% | Unreported | Unreported |
| Donley et al.22 | 3 | High fibula fracture with syndesmosis injury | ORIF 3 cases | 100% | Unreported | Unreported |
| Navarro Garcia et al.23 | 60 | Weber A: 9 Weber B: 38 Weber C: 13 |
ORIF 60 cases | 100% | Unreported | Unreported |
| Pina et al.24 | 92 | Weber A: 9 Weber B: 37 Weber C: 46 Posterior malleolus involved in 24 cases. |
ORIF 92 cases | 91% | Unreported | Mean AOFAS 90.93. |