Diagnosis, treatment and prognosis of ankle fractures

Abstract

Ankle fracture is a common injury with increasing incidence. The aim of this thesis was to assess aspects of the diagnosis, treatment and prognosis of ankle fractures. A systematic review was conducted to examine the diagnostic accuracy of the Ottawa Ankle and Midfoot Rules, a clinical decision rule used to identify people with a low probability of fracture that do not require imaging. Data from 68 studies showed that the Rules have high sensitivity and low and heterogeneous specificity and that different health professional can apply the Rules without affecting accuracy. A randomised controlled trial including 214 people with isolated and uncomplicated ankle fracture was conducted to assess if a rehabilitation program is more effective and cost-effective than advice after immobilisation removal for ankle fracture and to assess if outcomes were moderated by two subgroups: fracture severity (more severe versus less severe) and age and gender (women aged 50 years and older versus women aged less than 50 years and all men). Participants were followed-up for 6 months and the primary outcomes were activity limitation (Lower Extremity Functional Scale) and quality of life (Assessment of Quality of Life). The trial showed that rehabilitation was not more effective than advice and that outcomes were not moderated by fracture severity or by age and gender. Finally, the prognosis of physical function, operationalised as levels of activity limitation and physical activity, was assessed in a systematic review and a longitudinal study. Physical function improved significantly in the short- to medium-term and plateaus, not reaching a complete recovery, in the long-term. People with ankle fracture were shown to be less active and more sedentary than the general population. This thesis provided robust evidence regarding the diagnosis, treatment and prognosis of ankle fractures.