Nationwide incidence of lateral malleolar fracture surgery across 6 European countries: has recent evidence changed clinical practice?

Authors

  • Ville Ponkilainen Department of Orthopaedics and Traumatology, Tampere University Hospital, Wellbeing Services County of Pirkanmaa; University of Tampere, Tampere, Finland https://orcid.org/0000-0002-5026-4560
  • Thomas Ibounig Finnish Centre for Evidence-Based Orthopaedics (FICEBO), University of Helsinki; Department of Orthopaedics and Traumatology, Helsinki University Hospital, Finland https://orcid.org/0000-0001-9658-8571
  • Tim Jones Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning and Research Building, Level 1, Southmead Hospital, Bristol, UK
  • Aleksi Reito Department of Orthopaedics and Traumatology, Tampere University Hospital, Wellbeing Services County of Pirkanmaa; University of Tampere, Tampere; Department of Clinical Science, Intervention and Technology, Division of Orthopaedics and Biotechnology Karolinska Institutet, Stockholm, Sweden https://orcid.org/0000-0002-6903-6461
  • Tom J Crijns Department of Orthopedic Surgery, Mayo Clinic, Phoenix, AZ, USA
  • Michael Whitehouse Department of Orthopaedics and Traumatology, Helsinki University Hospital, Finland; National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK https://orcid.org/0000-0003-2436-9024
  • Li Felländer-Tsai Department of Clinical Science, Intervention and Technology, Division of Orthopaedics and Biotechnology Karolinska Institutet, Stockholm, Sweden https://orcid.org/0000-0003-0693-6080
  • Cyrill Suter Finnish Centre for Evidence-Based Orthopaedics (FICEBO), University of Helsinki; Department of Orthopaedics and Traumatology, Helsinki University Hospital, Finland
  • Lasse Rämö Finnish Centre for Evidence-Based Orthopaedics (FICEBO), University of Helsinki; Department of Orthopaedics and Traumatology, Helsinki University Hospital, Finland https://orcid.org/0000-0003-4154-8462
  • Teppo L N Järvinen Finnish Centre for Evidence-Based Orthopaedics (FICEBO), University of Helsinki; Department of Orthopaedics and Traumatology, Helsinki University Hospital, Finland https://orcid.org/0000-0003-3713-956X

DOI:

https://doi.org/10.2340/17453674.2025.44797

Keywords:

Foot and ankle, Fractures

Abstract

Background and purpose: Increased use of weightbearing radiographs to assess ankle mortise stability have suggested that most lateral malleolar fractures with a congruent mortise on initial radiographs can successfully be treated nonoperatively. We aimed to evaluate trends in the surgical management of isolated lateral malleolus fractures across Austria, England, Finland, Germany, Sweden, and Switzerland from 2013 to 2022
Methods: We performed a multi-register study to document the annual incidence of operative treatment for isolated lateral malleolus fractures through procedure codes across 6 European countries between 2013 and 2022. The annual incidence of operative treatment was calculated by dividing the total number of procedures per year by the year- and age-matched population based on publicly available demographics data.
Results: Across the 6 studied European countries, the incidence of surgery for lateral malleolar fracture varied 6-fold between the country with highest (Germany) and lowest (England) incidences; Germany: 37 (95% confidence interval [CI] 37–38) per 105; Switzerland: 34 (CI 32–35) per 105, Austria: 27 (CI 26–28) per 105, Finland: 17 (CI 16–18) per 105, Sweden: 8 (CI 7–9) per 105, and England: 6 (CI 6–7) per 105 in 2021. Over the 10-year study period, the incidence of surgery for lateral malleolar fractures declined notably in Sweden (–29%), Finland (–26%), England (–20%), and Switzerland (–14%), but remained stable in Germany and Austria.
Conclusion: The incidence of surgery for lateral malleolar fracture varied 6-fold across 6 studied European countries. Reductions of approximately 20–30% were observed in England, Sweden, and Finland (countries with the lowest baseline rates), while in Germany and Austria (countries with higher baseline rates), the incidence of surgery remained stable over the 10-year observation period.

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2025-10-10

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Ponkilainen, V., Ibounig, T., Jones, T., Reito, A., Crijns, T. J., Whitehouse, M., … Järvinen, T. L. N. (2025). Nationwide incidence of lateral malleolar fracture surgery across 6 European countries: has recent evidence changed clinical practice?. Acta Orthopaedica, 96, 763–770. https://doi.org/10.2340/17453674.2025.44797

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Vol. 96 (2025): Acta Orthopaedica

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Copyright (c) 2025 Ville Ponkilainen, Thomas Ibounig, Tim Jones, Aleksi Reito, Tom J Crijns, Michael Whitehouse, Li Felländer-Tsai, Cyrill Suter, Lasse Rämö, Teppo L N Järvinen

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Acta Orthopaedica (Scandinavica) content is available freely online as from volume 1, 1930. The journal owner owns the copyright for all material published until volume 80, 2009. As of June 2009, the journal has however been published fully Open Access, meaning the authors retain copyright to their work. As of June 2009, articles have been published under CC-BY-NC or CC-BY licenses, unless otherwise specified.
 
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