Management, Functional outcomes, and Prognostic Factors of Adult Bimalleolar Ankle Fractures in Resource-Limited and Conflict-Affected Settings: A living Systematic Review

Bimalleolar ankle fractures are among the most common unstable ankle injuries in adults and frequently require surgical stabilization to restore ankle congruity and function. These injuries are associated with substantial morbidity, prolonged disability, and risk of post-traumatic osteoarthritis if inadequately managed [1]. In resource-limited and conflict-affected settings, fracture management is often complicated by delayed presentation, shortages of orthopedic surgeons, limited access to implant systems and imaging, disrupted healthcare infrastructure, and restricted rehabilitation services. Despite these challenges, no living systematic review has comprehensively synthesized available evidence on treatment approaches, functional outcomes, and prognostic factors in these contexts. This protocol arms to systematically evaluate the management strategies, functional outcomes, complications, and prognostic factors associated with adult bimalleolar ankle fractures in resource-limited and conflict-affected settings.