Cultural variation in postoperative care after ankle fracture fixation: a binational matched cohort study

Ankle fractures are among the most common orthopedic injuries requiring operative management. Postoperative care varies across healthcare systems due to cultural, regulatory, and practice-based differences. This study evaluated whether such variation influences ankle fracture healing.

We conducted a retrospective cohort study at two Level 1 trauma centers, one in the United States and one in Chile, from 2015 to 2023. Patients included had sustained Weber B or C ankle fractures due to falls and were treated with ORIF, with available 3- and 6-month radiographs. Demographic, clinical, and operative variables were recorded. Genetic matching was used to balance key covariates between cohorts.

Of 250 patients, 110 remained after genetic matching (55 pairs) with well-balanced baseline characteristics (all standardized mean differences < 0.1). No significant differences in fracture union time were observed between cohorts in either unmatched or matched analyses. In the matched cohort, mean union time was 108.6 ± 60.6 days in the U.S. group and 124.8 ± 88.2 days in the Chilean group (p = 0.235). Sensitivity analyses demonstrated consistent findings. Complication rates were similar, with no differences in infection, delayed union, or nonunion; however, a higher proportion of Chilean patients had no complications (72.7 vs. 50.9%, p = 0.038).

In this matched binational cohort, patients with operatively treated ankle fractures demonstrated comparable healing outcomes despite differences in postoperative care strategies across healthcare systems. These findings highlight the reliability of fracture healing in this injury pattern with low rate of complications despite cultural and system-level variation, supporting opioid-sparing strategies in appropriately selected patients.