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

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.

Total knee replacement in a transtibial amputee.

We present the case of a man in his 60s with a transtibial amputation (TTA) undergoing total knee replacement (TKR) for symptomatic osteoarthritis (OA). It is unusual to develop OA in the ipsilateral knee to TTA; and while it is postulated that this is because patients preferentially load their unaffected limb to protect the TTA-sided knee, there is also the ability to offload specific knee compartments through prosthetic adjustment. When planning TKR in such patients, it is important to consider several technical challenges in order to prevent a poor outcome. The literature is sparse with evidence to guide decision-making, and this case report and literature review aims to summarise our preoperative planning and intraoperative technique, which ultimately resulted in a good outcome.