The association between person and fracture characteristics with patient reported outcome after ankle fractures in adults: A systematic review

Background: The incidence of ankle fractures is increasing and the clinical outcome is highly variable. Question: What person and fracture characteristics are associated with patient reported outcomes after surgically or conservatively managed ankle fractures in adults? Data sources: Medline, EMBASE, and Allied and Complimentary Health Medical Database (AMED) databases were searched from the earliest available date until 16th July 2020. Study selection: Prognostic factors studies recruiting adults of age 18 years or older with a radiologically confirmed ankle fracture, and evaluating function, symptoms and quality of life by patient reported outcome measures, were included. Study appraisal/synthesis methods: Risk of bias of individual studies was assessed by the Quality in Prognostic Factors Studies tool. Correlation coefficients were calculated and data were analysed using narrative synthesis. Results: Fifty-one phase 1 explanatory studies with 6177 participants met the inclusion criteria. Thirty-one studies were rated as high risk of bias using the Quality in Prognostic Factors Studies tool. There was low quality evidence that age, body mass index, American Society of Anesthesiologists classification and pre-injury mobility were associated with function, and low to moderate quality evidence that age, smoking and American Society of Anesthesiologists classification were associated with quality of life. No person characteristics were associated with symptoms and no fracture characteristics were associated with any outcomes. Conclusion: There was low to moderate quality evidence that person characteristics may be associated with patient reported function and quality of life following ankle fracture. Systematic review registration: PROSPERO registration number CRD42020184830