Management of Ankle Fractures – A Survey of Practices of Orthopaedic Surgeons in Nigeria

Abstract

Background: Ankle fractures are fairly common worldwide but there is scanty literature on the man-agement of these fractures from sub-Saharan Africa. This study provides a broad picture of the prac-tices of orthopaedic surgeons in Nigeria in managing ankle fractures. Consequently, these practices can be updated, areas for further research highlighted and subsequently, guidelines developed con-cerning the contextual management of these fractures in Nigeria.Methods: This survey was carried out using online and hard copy questionnaires, distributed at an annual conference of the Nigerian Orthopaedic Association and sent to three regional centres of orthopaedic practice, respectively. The data was analysed to determine frequencies.Results: There were 114 male and 16 female respondents. Sixty-one percent of the respondents preferred the Danis-Weber classification. While fifty-six percent of the cohort noted that most of these patients present to traditional bone setters before seeking orthodox care, seventy percent con-sidered arrival to hospital in 1 – 4 weeks post injury to be the norm. The Ottawa ankle rules are ap-plied by most (56%) of the participants. About a sixth (17.5%) of our cohort apply syndesmosis screws routinely, while twenty-eight percent of them do not remove these screws. The commonest post-operative complications encountered were chronic pain, flap necrosis and local sepsis. Sixty percent of the surgeons regarded post-operative physiotherapy as beneficial.Conclusions: While a preference for traditional bone setter care and delayed presentation ham-pers formal care of ankle fractures, orthopaedic surgeons in Nigeria tend to apply nonoperative ap-proaches. Patient assessment and any surgical intervention are usually based on modern principles.