Isolated fracture of the lateral malleolus requires no treatment

Ryd, Leif; Bengtsson, Sten

doi:10.3109/17453679209154764

Cited by 47 publications

(7 citation statements)

References 11 publications

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“…Our study is not the first attempt to streamline the non-operative treatment of ankle fractures 2425 27 28 29 30 46 47 48 In fact, on the basis of evidence from biomechanical studies suggesting that early mechanical stimuli can enhance fracture healing,31 32 33 a few attempts of treating isolated fibula fractures without any sturdy external ankle support had been carried out 2728 29 However, possibly due to absence of high quality evidence on the effectiveness and safety of more simple non-operative treatment strategies, the current tenet of six weeks of cast immobilisation coupled with a series of follow-up radiographs—even weekly48—still remains the ideal treatment of stable Weber B type fractures 8…”

Section: Discussionmentioning

confidence: 99%

“…25 27 28 29 30 46 47 48 In fact, on the basis of evidence from biomechanical studies suggesting that early mechanical stimuli can enhance fracture healing,31 32 33 a few attempts of treating isolated fibula fractures without any sturdy external ankle support had been carried out 2728 29 However, possibly due to absence of high quality evidence on the effectiveness and safety of more simple non-operative treatment strategies, the current tenet of six weeks of cast immobilisation coupled with a series of follow-up radiographs—even weekly48—still remains the ideal treatment of stable Weber B type fractures 819 20 22 23 This is based primarily on bioplausibility—experimental studies showing that it takes six weeks for any fracture to reach a sufficient strength to resist weightbearing induced strains49—and evidence from clinical trials showing satisfactory outcomes in patients with minimally or non-displaced Weber B type fibula fractures 16…”

Section: Discussionmentioning

confidence: 99%

“…Traditionally, the assessment of the stability of the ankle mortise in patients with an isolated fibula fracture has relied on plain radiography and consensus based indicators for instability: fracture gap more than 2 mm, particularly when complemented with “red flag” clinical findings on the medial side of the ankle (tenderness, swelling, haematoma) 1617 18 24 27 28 29 30 Occasional cases of treatment failures—widening of the ankle mortise—has been associated with this treatment strategy 1618 28 In our trial, we used external rotation stress testing, a method gaining popularity,6 7 8 9 11 12 13 14 15 to confirm the stability of the ankle mortise immediately after the injury.…”

Section: Discussionmentioning

confidence: 99%

“…23 24 25 26 Awareness of this trade-off between benefits and harms has been a catalyst towards considering shorter, more functional and less bothersome non-operative strategies that would still result in successful fracture healing 2425 27 28 29 30…”

Section: Introductionmentioning

confidence: 99%

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Three week versus six week immobilisation for stable Weber B type ankle fractures: randomised, multicentre, non-inferiority clinical trial

Kortekangas

Haapasalo

Flinkkilä

et al. 2019

BMJ

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ObjectiveTo determine whether treatment of isolated stable Weber B type ankle fractures with a cast or a simple orthotic device for three weeks produces non-inferior outcomes compared with conventional immobilisation in a cast for six weeks.DesignRandomised, pragmatic, non-inferiority, clinical trial with blinded outcome assessment.SettingTwo major trauma centres in Finland, 22 December 2012 to 6 June 2016.Participants247 skeletally mature patients aged 16 years or older with an isolated Weber B type fibula fracture and congruent ankle mortise in static ankle radiographs.InterventionsParticipants were randomly allocated to conventional six week cast immobilisation (n=84) or three week treatment either in a cast (n=83) or in a simple orthosis (n=80).Main outcome measuresThe primary, non-inferiority, intention-to-treat outcome was the Olerud-Molander Ankle Score at 12 months (OMAS; range 0-100; higher scores indicate better outcomes and fewer symptoms). The predefined non-inferiority margin for the primary outcome was −8.8 points. Secondary outcomes were ankle function, pain, quality of life, ankle motion, and radiographic outcome. Follow-up assessments were performed at 6, 12, and 52 weeks.Results212 of 247 randomised participants (86%) completed the study. At 52 weeks, the mean OMAS was 87.6 (SD 18.3) in the six week cast group, 91.7 (SD 12.9) in the three week cast group, and 89.8 (SD 18.4) in the three week orthosis group. The between group difference at 52 weeks for the three week cast versus six week cast was 3.6 points (95% confidence interval −1.9 to 9.1, P=0.20), and for the three week orthosis versus six week cast was 1.7 points (−4.0 to 7.3, P=0.56). In both comparisons, the confidence intervals did not include the predefined inferiority margin of −8.8 points. The only statistically significant between group differences observed in the secondary outcomes and harms in the two primary comparisons were slight improvement in ankle plantar flexion and incidence of deep vein thrombosis, both in the three week orthosis group versus six week cast group.ConclusionImmobilisation for three weeks with a cast or orthosis was non-inferior to conventional cast immobilisation for six weeks in the treatment of an isolated stable Weber B type fracture.Trial registrationClinicalTrials.gov NCT01758835.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Three week versus six week immobilisation for stable Weber B type ankle fractures: randomised, multicentre, non-inferiority clinical trial

Kortekangas

Haapasalo

Flinkkilä

et al. 2019

BMJ

View full text Add to dashboard Cite

show abstract

“…Nonoperative treatment can yield good results in SER Type II-III injuries without dislocation. [5][6][7][8][9][10] Surgical treatment could lead to improved outcome for dislocated fractures, SER Type IV injuries, and fractures in the elderly. [11][12][13][14][15][16][17][18] However, the long-term prognosis of both therapeutic modalities is hardly known.…”

Section: Introductionmentioning

confidence: 99%