![]() Each investigator rated twice the Coleman Methodology Score assessment and together they discussed scores where more than a two-point difference was evident, until consensus was reached. An investigation scoring 100 would represent a perfect study design with no influence of chance, various biases and confounding factors. Two investigators separately read and evaluated each paper using the Coleman Methodology Score, a 10-criteria validated scoring system assessing the quality of the study method, with the final score ranging from 0 to 100 (Table 2). The inclusion and exclusion criteria are detailed in Figure 1 and Table 1. The reference lists of the selected articles were reviewed by hand to identify articles not included at the first electronic search. When inclusion or exclusion was not possible based on the abstract, the full-text versions were downloaded. Two authors (ADB and LS) independently assessed the abstract of each publication, selecting on the basis of its content, and excluding articles without abstract available. Biomechanical reports, studies on animals, cadavers, in vitro or animal studies, case reports, literature reviews, technical notes, letters to editors and instructional course were also excluded. Medline (PubMED), EMBASE, CINHAL, Cochrane, Sports Discus and Google scholar databases were accessed up to 12 October 2012 to identify articles published in English, Spanish, French, Portuguese and Italian in peer-reviewed journals, reporting data and information on return to sports after ankle fracture, without any distinction for type and severity of fracture, level and type of sports activity. We performed a systematic search of the literature using the combined keywords ‘ankle fractures’ 'ankle injuries’ ‘athletes’ 'sports’ ‘return to sport’ 'recovery’’ ‘operative fixation’ 'pinning’ ‘return to activity’ with no limit for year of publication and level of evidence of the study. We used the modified Coleman methodology score, a system validated to assess the quality of clinical studies published in several fields of musculoskeletal medicine, including tendinopathy, sports traumatology and general orthopaedics. In our search, we have also considered the return to sports after bone stress injury. The aim of this review is to shed some light about the prognosis of these injuries in athletes, and provide some additional information on the time they will take to resume sports activity. Examining the literature, there is little evidence about the impact of these fractures in athletes, the time that athletes take to return to pre-injury sports activity, and their performance after trauma. 6 On the other hand, information about return to sports are anecdotal, not based on actual data. Management of ankle fractures is well defined, and open reduction and internal fixation is an excellent option, 5 especially for athletes who require early mobilization and return to sports. ![]() 4 Therefore, surgeons have to inform patients on the possibility and modality that they can return to high demand sports activity after a trauma. 1–3 The public health impact of these injuries is thought to increase in the future as the current trend is to practice sports at all ages. Ankle fractures, open reduction and internal fixation, functional outcome measures, systematic review IntroductionĪnkle injuries are a significant source of morbidity for athletes, accounting for 15–25% of all sports injuries. ![]()
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