Fractures of the lateral malleolus – a retrospective before-and-after study of treatment and resource utilization following the implementation of a structured treatment algorithm

Rydberg, Emilia Möller; Skoglund, Jonas; Brezicka, Hampus; Ekelund, Jan; Sundfeldt, Mikael; Möller, Michael; Wennergren, David

doi:10.1186/s12891-022-05358-x

Cited by 6 publications

(4 citation statements)

References 30 publications

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“…The most important nding of this long-term follow-up study is that treating stable ankle fractures nonsurgically is safe and does not lead to an increased risk of non-union, mal-union or increased reoperation rates. The current study builds upon the ndings of a previous study by Rydberg et al that demonstrated that implementing a standardised treatment algorithm for lateral malleolar ankle fractures led to a considerable decrease in surgical intervention (17). The present study can conclude that this approach is safe and reliable long term.…”

Section: Discussionsupporting

confidence: 72%

Non-surgical treatment of lateral malleolar fractures is safe - Long-term follow-up of a comprehensive treatment algorithm

Börjesson,

Johannesson,

Ekelund

et al. 2024

Preprint

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Introduction: A previous study conducted at Sahlgrenska University Hospital (SU) revealed a significant variation in the treatment of ankle fractures, which resulted in the creation of a treatment algorithm (TA). The aim of TA was to standardise treatment and reduce the number of unnecessary surgical procedures. A follow-up study concluded that the number of surgeries had significantly decreased since the introduction of the TA. However, the long-term effects of the TA and the reduced number of surgical procedures remained unclear. Aim: To analyse the long-term effects of a structured TA for ankle fractures regarding complications and reoperation rates. Method: The present study is a long-term follow-up of the same two cohorts of patients with lateral malleolar fractures of type AO/OTA44-B1 as studied in the previous studies on the TA for ankle fractures at SU. The current study compares a group of AO/OTA 44B1-fractures treated before the introduction of the TA, the pre-TA cohort (n=410), with a group treated after the introduction of the TA, the post-TA cohort (n=333). Both groups were followed for a minimum of four years, and the outcomes were reoperation or complication. Reoperation was defined as any surgical procedure that occurred 30 days or more after the initial injury. Results: The results demonstrate a statistically significant reduction in the reoperation rate for lateral malleolar ankle fractures from 7.1% to 2.4% (p = 0.006) following the introduction of a TA that reduced the number of primary surgical procedures. Hardware-related complaints were the leading cause of reoperation in both cohorts. Three major reoperations were observed in the Pre-TA cohort compared to none in the Post-TA cohort. The present study revealed no increase in the frequency of late surgeries due to non-union. Conclusion: Treating stable ankle fractures non-surgically does not lead to an increase in reoperations, complications or late surgeries due to non-union. In fact, a structured treatment algorithm that reduce the number of primary surgical procedures for lateral malleolar fractures of type AO/OTA44-B1 also led to a significant reduction in reoperation rates and no increase in failure rates. This long-term follow-up demonstrates that a non-surgical approach to isolated lateral malleolar fractures is safe.

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Section: Discussionsupporting

confidence: 72%

Non-surgical treatment of lateral malleolar fractures is safe - Long-term follow-up of a comprehensive treatment algorithm

Börjesson,

Johannesson,

Ekelund

et al. 2024

Preprint

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“…Ankle fractures are the third most common type of fracture, affecting both sexes and all age groups [ 1 – 3 ]. The spectrum of ankle fractures ranges from simple avulsions that can be safely treated non-surgically without follow-up to complex, open injuries that require multiple surgeries and long-term rehabilitation [ 4 ]. An increasing incidence of ankle fractures, especially in the elderly, has been reported in several studies over the past few years [ 5 – 8 ].…”

Section: Introductionmentioning

confidence: 99%

Epidemiology of more than 50,000 ankle fractures in the Swedish Fracture Register during a period of 10 years

et al. 2023

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Background Despite being one of the most common types of fracture, there is a lack of epidemiological studies involving ankle fractures of all kinds. Since 2012, the Swedish Fracture Register (SFR) has prospectively collected data on surgically and non-surgically treated ankle fractures. The aim of this study is to describe the epidemiology of ankle fractures between 2012 and 2022. Methods All ankle fractures registered in the SFR between 1 April 2012 and 31 March 2022 in patients aged 16 years or older were included. Information on age, sex, mechanism of injury, fracture classification according to AO/OTA and high- or low-energy trauma was retrieved from the SFR. Results During the study period, 56,439 patients sustained 57,443 ankle fractures. Women (61%) were more commonly affected than men (39%). The mean age at the time of injury was 55 years. Men were found to be younger at the time of injury compared with women. Women were found to sustain open fractures more frequently, whereas the men more frequently sustained high-energy trauma. The most common mechanism of injury for all ankle fractures and for each AO/OTA44 fracture group separately was a simple fall. A seasonal variation in ankle fractures was found, where the number of ankle fractures peaked during the between November and March. Conclusions This study presents the epidemiology of all AO/OTA types of ankle fractures. We have demonstrated that most ankle fractures are caused by a simple fall and occur during wintertime. Women are more commonly affected than men and are older at the time of injury. These findings indicate that age-related skeletal fragility, as well as an increasing risk of simple falls in the elderly, may be risk factors for ankle fractures. This study will contribute to the planning of primary prevention for ankle fractures.

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“…The low frequency of refractures might depend on advice on restrictions already given to children and their families, although if these restrictions are revised, it would be advisable to continuously follow the frequency of refractures to be able to detect any increase, and the SFR is a suitable tool for conducting this. 26 The current study has a number of strengths and limitations. The primary strength of the study is that it is based on a large cohort of more than 40,000 paediatric fractures with data from a population-based nationwide register that has been thoroughly validated and shown to have high coverage, completeness, and accuracy of registration.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

How common are refractures in childhood?

Amilon,

Bergdahl,

Fridh

et al. 2023

Bone Joint J

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AimsThe aim of this study was to describe the incidence of refractures among children, following fractures of all long bones, and to identify when the risk of refracture decreases.MethodsAll patients aged under 16 years with a fracture that had occurred in a bone with ongoing growth (open physis) from 1 May 2015 to 31 December 2020 were retrieved from the Swedish Fracture Register. A new fracture in the same segment within one year of the primary fracture was regarded as a refracture. Fracture localization, sex, lateral distribution, and time from primary fracture to refracture were analyzed for all long bones.ResultsOf 40,090 primary fractures, 348 children (0.88%) sustained a refracture in the same long bone segment. The diaphyseal forearm was the long bone segment most commonly affected by refractures (n = 140; 3.4%). The median time to refracture was 147 days (interquartile range 82 to 253) in all segments of the long bones combined. The majority of the refractures occurred in boys (n = 236; 67%), and the left side was the most common side to refracture (n = 220; 62%). The data in this study suggest that the risk of refracture decreases after 180 days in the diaphyseal forearm, after 90 days in the distal forearm, and after 135 days in the diaphyseal tibia.ConclusionRefractures in children are rare. However, different fractured segments run a different threat of refracture, with the highest risk associated with diaphyseal forearm fractures. The data in this study imply that children who have sustained a distal forearm fracture should avoid hazardous activities for three months, while children with a diaphyseal forearm fracture should avoid these activities for six months, and for four and a half months if they have sustained a diaphyseal tibia fracture.Cite this article: Bone Joint J 2023;105-B(8):928–934.

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Fractures of the lateral malleolus – a retrospective before-and-after study of treatment and resource utilization following the implementation of a structured treatment algorithm

Cited by 6 publications

References 30 publications

Non-surgical treatment of lateral malleolar fractures is safe - Long-term follow-up of a comprehensive treatment algorithm

Non-surgical treatment of lateral malleolar fractures is safe - Long-term follow-up of a comprehensive treatment algorithm

Epidemiology of more than 50,000 ankle fractures in the Swedish Fracture Register during a period of 10 years

How common are refractures in childhood?

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