A systematic review investigating the effectiveness of surgical versus conservative management of unstable ankle fractures in adults

Elgayar, L; Arnall, FA; Barrie, J

Abstract

Nine percent of all fractures affect the ankle, with an annual incidence of 122/100,000 in Edinburgh, UK. While unstable fractures are usually treated surgically, there has been no recent systematic review of the evidence supporting this decision. In this systematic review, relevant electronic databases (such as MEDLINE and CINHAL) were searched from inception to February 2017. Five randomized controlled trials that examined surgical versus conservative interventions in 951 adults with closed ankle fractures, with follow-up for at least 6 months, were selected for further synthesis of evidence. The risk of selection bias in all selected trials was relatively low. However, most of the trials had a high risk of performance and detection bias. Three of the 5 selected trials used the validated functional Olerud Molander Ankle Score. One trial (n = 43), reported a statistically better score for the surgical group at 27-month follow-up, whereas a second (n = 81) and a third (n = 620) trial found no significant difference at 12 and 6 months, respectively. No significant differences between surgical and conservative treatments were reported in 2 trials (n = 111) and (n = 96) in nonvalidated functional outcome measures. Other outcomes were malunion (9/334 [2.6%] versus 48/301 [15.9%], p < .0001) and nonunion (3/408 [0.7%] versus 28/383 [7.3%], p < .0001) and were considerably higher in the conservatively treated group. Early treatment failure was significantly lower with surgery (7/435 [1.6%] versus 70/419 [16.7%], p < .0001). The risk of malunion, nonunion, and loss of reduction were greater in nonoperative care. However, the 2 treatment approaches provided equivalent functional outcomes. [Abstract copyright: Copyright © 2018 the American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.]

Citation

Elgayar, L., Arnall, F., & Barrie, J. (2019). A systematic review investigating the effectiveness of surgical versus conservative management of unstable ankle fractures in adults. Journal of Foot and Ankle Surgery, 58(5), 933-937. https://doi.org/10.1053/j.jfas.2018.12.017

• Journal Article Type: Article
• Online Publication Date: Aug 30, 2019
• Publication Date: Sep 1, 2019
• Deposit Date: Dec 4, 2019
• Journal: The Journal of foot and ankle surgery
• Print ISSN: 1067-2516
• Publisher: Elsevier
• Volume: 58
• Issue: 5
• Pages: 933-937
• DOI: https://doi.org/10.1053/j.jfas.2018.12.017
• Keywords: conservative management, functional outcome, malleolar fracture, radiological evaluation, surgery, unstable ankle fracture
• Publisher URL: https://doi.org/10.1053/j.jfas.2018.12.017
• Related Public URLs: https://www.sciencedirect.com/journal/the-journal-of-foot-and-ankle-surgery
• Additional Information: Additional Information : ** From PubMed via Jisc Publications Router **Journal IDs: eissn 1542-2224 **Article IDs: pubmed: 31474404; pii: S1067-2516(18)30548-9 **History: submitted 28-11-2017