Fractures of the posterior malleolus: a systematic review and analysis of patient-reported outcome scale selection

Eur J Orthop Surg Traumatol. 2023 May;33(4):1125-1131. doi: 10.1007/s00590-022-03261-8. Epub 2022 Apr 16.


Purpose: Despite the extensive use of PROs in ankle fracture research, no study has quantified which PROs are most commonly used for assessing outcomes of patients who sustain fractures of the posterior malleolus. The purpose of this study was therefore to quantify which PROs are most commonly used for outcome research after posterior malleolus fractures.

Methods: A systematic search was performed using the preferred reporting items for systematic reviews and meta-analyses guidelines. Articles were identified through Pubmed, EMBASE, Web of Science, and cochrane central register of controlled trials through May of 2021. Included articles were analyzed for the primary outcome of the most commonly reported PRO.

Results: The American orthopedic foot and ankle ankle-hindfoot score (AOFAS) was the most commonly used PRO for assessment of posterior malleolus fracture outcomes, used in 37 of 72 studies (51.4%). The second and third most common were the olerud-molander ankle score (OMAS) (22 studies, 30.6%) and the visual analogue score (VAS) (21 studies, 29.2%). Eleven different PROs were used only once. Quality of evidence was graded as low given the percentage of studies that were observational or case series (68 of 72 studies, 94.4%).

Conclusion: Investigators have used many different PROs to assess outcomes for posterior malleolus fractures, the most common of which are the AOFAS, OMAS, and VAS. Future investigators should attempt to unify outcome reporting for these injuries.

Keywords: Fracture; Outcome reporting; Patient-reported outcomes; Posterior malleolus.

Publication types

  • Systematic Review

MeSH terms

  • Ankle Fractures* / etiology
  • Ankle Joint
  • Fracture Fixation, Internal / adverse effects
  • Humans
  • Retrospective Studies
  • Tibia
  • Treatment Outcome