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Surgical outcome of avulsion fractures of the distal fibula: a systematic literature review

  • Orthopaedic Surgery
  • Published:
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Abstract

Purpose

To provide a systematic overview of clinical and radiographic outcomes in patients who underwent surgical treatment of a painful avulsion fragment of the distal fibula also known as posttraumatic os subfibulare.

Methods

A systematic literature search across two major sources (PubMed and Scopus) was performed. Twenty-seven studies were included and analyzed using the modified Coleman score to assess the methodologic quality.

Results

The surgical treatment of symptomatic os subfibulare, with or without concomitant ankle instability, generally results in substantial improvement in clinical and radiographic outcomes with relative low complication rates. Clinical outcome measures may not be affected by the presence of ankle instability or by the fragment size. The methodological quality of analyzed studies was satisfactory.

Conclusion

Posttraumatic os subfibulare may result in chronic pain and ankle instability. If surgery is indicated, ankle instability should be concomitantly addressed when present. Based on available literature, satisfactory postoperative outcomes can be reliably expected following surgical treatment.

Level of evidence

Systematic Review of Level III and Level IV Studies, Level IV.

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Acknowledgements

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Funding

This research did not receive any financial support from funding agencies.

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Author notes

  1. Carsten Schlickewei and Nicola Krähenbühl have contributed equally to the development of this project.

Authors and Affiliations

  1. Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251, Hamburg, Germany

    Carsten Schlickewei, Tim Rolvien, Julian Stürznickel, Sinef Yarar-Schlickewei, Karl-Heinz Frosch & Alexej Barg

  2. Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland

    Nicola Krähenbühl

  3. Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA

    Graham DeKeyser & Alexej Barg

  4. Department of Trauma and Orthopaedic Surgery, BG Hospital Hamburg, Bergedorfer Str. 10, 21033, Hamburg, Germany

    Karl-Heinz Frosch & Alexej Barg

Authors
  1. Carsten Schlickewei
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  2. Nicola Krähenbühl
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  3. Tim Rolvien
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  7. Karl-Heinz Frosch
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  8. Alexej Barg
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Contributions

CS: study conception and planning, literature search, studies selection, data extraction, data analysis, studies tables preparation, and manuscript writing. NK: study conception and planning, literature search, studies selection, data extraction, flowchart figure preparation, studies tables preparation, and manuscript writing. TR: data analysis, studies tables preparation, and manuscript writing. JS: data analysis, studies tables preparation, and manuscript writing. SYS: literature search, studies selection, data extraction, and manuscript writing. GD: data analysis, studies tables preparation, and manuscript writing. KHF: manuscript writing and project supervision. AB: study conception and planning, literature search, data analysis, statistical analysis, studies tables preparation, manuscript writing, and project supervision.

Corresponding author

Correspondence to Alexej Barg.

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Schlickewei, C., Krähenbühl, N., Rolvien, T. et al. Surgical outcome of avulsion fractures of the distal fibula: a systematic literature review. Arch Orthop Trauma Surg 143, 1275–1291 (2023). https://doi.org/10.1007/s00402-021-04256-6

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