{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T04:18:37Z","timestamp":1772165917414,"version":"3.50.1"},"reference-count":24,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,10,16]],"date-time":"2024-10-16T00:00:00Z","timestamp":1729036800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,10,16]],"date-time":"2024-10-16T00:00:00Z","timestamp":1729036800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100005760","name":"University of Gothenburg","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100005760","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Musculoskelet Disord"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>A study at Sahlgrenska University Hospital (SU) found significant variation in the treatment of ankle fractures, leading to the development of a structured treatment algorithm (TA). The TA aimed to standardise treatment and reduce the number of unnecessary surgical procedures. A follow-up study concluded that the number of surgeries had significantly decreased since the TA was introduced. However, the long-term effects of the TA and the reduced number of surgical procedures remain unclear. The aim of the study was to analyse the long-term effects of a structured TA for ankle fractures, focusing on complications and reoperation rates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>\n                      The present study is a long-term follow-up of the same two cohorts of patients with lateral malleolar fractures of type AO\/OTA44-B1, as studied in the previous studies on the TA for ankle fractures at SU. The current study compares a group of AO\/OTA 44B1 fractures treated before introducing the TA, the pre-TA cohort (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009410), with a group treated after introducing the TA, the post-TA cohort (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009333). Both cohorts were followed for at least four years, and the outcomes were reoperation or complication. Reoperation was defined as any surgical procedure performed\u2009\u2265\u200930 days after the injury.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The results highlight a statistically significant reduction in the reoperation rate for lateral malleolar ankle fractures from 7.1 to 2.4% (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.006) after introducing a TA that reduced the number of primary surgical procedures. Hardware-related issues were identified as the dominant cause of reoperation in both cohorts. Three major reoperations were observed in the pre-TA cohort compared to none in the post-TA cohort. The present study revealed no increase in the frequency of reoperations (late surgeries) due to non-union.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The non-surgical treatment of stable ankle fractures does not lead to an increase in reoperations caused by non-union. A TA that reduces the need for primary surgical procedures for lateral malleolar fractures of type AO\/OTA44-B1 has resulted in a significant decrease in reoperation rates and no increase in failure rates. This long-term follow-up demonstrates that a non-surgical approach to isolated lateral malleolar fractures is safe.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12891-024-07924-x","type":"journal-article","created":{"date-parts":[[2024,10,16]],"date-time":"2024-10-16T00:02:01Z","timestamp":1729036921000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Non-surgical treatment of lateral malleolar fractures is safe: long-term follow-up of a comprehensive treatment algorithm"],"prefix":"10.1186","volume":"25","author":[{"given":"Erik","family":"B\u00f6rjesson","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karolina","family":"Johannesson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan","family":"Ekelund","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emilia M\u00f6ller","family":"Rydberg","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2024,10,16]]},"reference":[{"issue":"8","key":"7924_CR1","doi-asserted-by":"publisher","first-page":"691","DOI":"10.1016\/j.injury.2006.04.130","volume":"37","author":"CM Court-Brown","year":"2006","unstructured":"Court-Brown CM, Caesar B. 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All patients were informed at registration in the Swedish Fracture Register that they had the right to withdraw. According to Swedish legislation, national quality registers do not require signed consent from the individual registered patient [\n                      \n                      ]. All methods were carried out in accordance with relevant guidelines and regulations.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"818"}}