Clinical outcomes of ankle fractures in sub-Saharan Africa: a systematic review

Peter Samuel Edward Davies, Rachel Pennington, Anil Singh Dhadwal, Linda Chokotho, Nohakhelha Nyamulani, Chiku Mpanga, Simon Matthew Graham (Lead / Corresponding author)

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    Purpose: Ankle fractures may cause disability and socioeconomic challenges, even when managed in a high-resource setting. The outcomes of ankle fractures in sub-Saharan Africa are not widely reported. We present a systematic review of the patient-reported outcomes and complications of patients treated for ankle fractures in sub-Saharan Africa.

    Methods: Medline, Embase, Google Scholar and the Cochrane Central Register of Controlled Trials were searched, utilising MeSH headings and Boolean search strategies. Ten papers were included. Data included patient demographics, surgical and non-surgical management, patient-reported outcome measures and evidence of complications.

    Results: A total of 555 patients with ankle fractures were included, 471 of whom were followed up (range 6 weeks-73 months). A heterogenous mix of low-quality observational studies and two methodologically poor-quality randomised trials demonstrated mixed outcomes. A preference for surgical management was found within the published studies with 87% of closed fractures being treated operatively. A total of five different outcome scoring systems were used. Most studies included in this review were published by well-resourced organisations and as such are not representative of the actual clinical practice taking place.

    Conclusion: The literature surrounding the clinical outcomes of ankle fractures in sub-Saharan Africa is sparse. There appears to be a preference for surgical fixation in the published literature and considering the limitations in surgical resources across sub-Saharan Africa this may not be representative of real-life care in the region.

    Original languageEnglish
    Pages (from-to)547–557
    Number of pages11
    JournalEuropean Journal of Orthopaedic Surgery and Traumatology
    Early online date15 Oct 2022
    Publication statusPublished - Apr 2023


    • Ankle
    • Fracture
    • Africa
    • Outcome
    • PROM


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