Malleolar Fractures

Sanders, David; Manjoo, Ajay

doi:10.1002/9781444345100.ch64

Cited by 2 publications

(4 citation statements)

References 21 publications

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“…17 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. Given that not a single loss of congruence of the ankle mortise was observed over the course of our 52 week follow-up despite allowing participants to weightbear as tolerated immediately after injury and enrolling more “clinically severe” injury patterns than most previous trials16 17 18 24 27 28 29 30 (table 1), the strategy proved successful.…”

Section: Discussionmentioning

confidence: 99%

“…3 4 5 6 7 8 These fractures can be either stable or unstable depending on the accompanying soft tissue injury 67 8 9 10 11 12 13 14 15 16 The stability of the ankle mortise has fundamental clinical relevance, as it dictates the treatment strategy 67 8 9 10 11 12 13 14 15 16 Stable ankle fractures can be treated non-surgically7 8 16 17 18 19 20 and account for about half of ankle fractures 1…”

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: Introductionmentioning

confidence: 99%

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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“…[1][2][3][4][5][6][7][8] In this particular fracture type, the ankle mortise is either stable or unstable depending on accompanying soft tissue injury. [5][6][7][8][9][10][11][12][13][14][15] External-rotation (ER) stress testing is the most reliable means to assess the stability of the ankle mortise. 8 10-12 Ankle mortise stability has fundamental clinical relevance, as it dictates the subsequent treatment strategy.…”

Section: Introduction Background and Rationalementioning

confidence: 99%

“…8 10-12 Ankle mortise stability has fundamental clinical relevance, as it dictates the subsequent treatment strategy. [5][6][7][8][9][10][11][12][13][14][15][16] If left untreated, an unstable ankle mortise may lead to compromised fracture healing, increased risk of post-traumatic osteoarthritis, and subsequently, poor functional outcome. 5-7 10-14 Therefore, existing literature quite unanimously recommends surgery for unstable Weber-B fibular fractures.…”

Section: Introduction Background and Rationalementioning

confidence: 99%

Surgery versus non-operative treatment for ER-stress unstable Weber-B unimalleolar fractures: a study protocol for a prospective randomized non-inferiority (Super-Fin) trial

Kortekangas

Lehtola

Leskelä

et al. 2021

BMJ Surg Interv Health Technologies

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Roughly two-thirds of ankle fractures are unimalleolar injuries, the Weber B-type fibula fracture being by far the most common type. Depending on the trauma and the accompanying soft-tissue injury, these fractures are either stable or unstable. Current clinical practice guidelines recommend surgical treatment for unstable Weber B-type fibula fractures. An ongoing randomized, parallel group, non-inferiority trial comparing surgery and non-operative treatment for unstable Weber B-type ankle fractures with allocation ratio 1:1. The rationale for non-inferiority design is as follows: By being able to prove non-inferiority of non-operative treatment, we would be able to avoid complications related to surgery. However, the primary concern related to non-operative treatment is increased risks of ankle mortise incongruency, leading to secondary surgery, early post-traumatic osteoarthritis and poor function. After providing informed consent, 126 patients aged 16 years or older with an unimalleolar Weber B-type unstable fibula fracture were randomly assigned to surgery (open reduction and internal fixation) or non-operative treatment (6-week cast immobilization). We have completed the patient enrolment and are currently in the final stages of the 2-year follow-up. The primary, non-inferiority outcome is the Olerud-Molander Ankle Score (OMAS) at 2 years (primary time point). The predefined non-inferiority margin is set at 8 OMAS points. Secondary outcomes include the Foot and Ankle Score, a 100 mm Visual Analogue Scale for function and pain, the RAND-36-Item Health Survey for health-related quality-of-life, the range-of-motion of the injured ankle, malunion (ankle joint incongruity) and fracture union. Treatment-related complications and harms; symptomatic non-unions, loss of congruity of the ankle joint, reoperations and wound infections will also be recorded. We hypothesize that non-operative treatment yields non-inferior functional outcome to surgery, the current standard treatment, with no increased risk of harms.

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Malleolar Fractures

Cited by 2 publications

References 21 publications

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

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

Surgery versus non-operative treatment for ER-stress unstable Weber-B unimalleolar fractures: a study protocol for a prospective randomized non-inferiority (Super-Fin) trial

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