Operative Versus Non Operative Treatment for Unstable Ankle Fractures
Condition: Ankle Injuries
MeSH terms: Ankle Fractures; Ankle Injuries
Study type: Interventional

Summary: 
      The purpose of the study is to compare functional outcomes and recovery following surgical
      and non surgical treatment of potentially unstable , isolated fibula fractures. Secondary
      objectives are to compare the re-operation rate, time to union and complications between the
      two treatment groups.

      The primary research questions:

        1. Does surgery provide a better functional outcome compared to non operative treatment of
           undisplaced, unstable fractures?

        2. Do patients with these fractures return to activities faster after operative or non
           operative treatment?

        3. Are complications more common with operative or non operative care?
    

Detailed description: 
      The most controversial ankle fracture is the Weber B fracture in which the fibular (or
      lateral malleolar) fracture begins at the level of the ankle mortise and extends proximal and
      lateral. This fracture can exist as isolated fractures of the lateral malleolus, or
      bimalleolar injuries in which both lateral and medial malleoli are fractured. When both
      malleoli are fractured, the ankle has lost all of its bony support and is unstable. In
      contrast, if only the lateral malleolus is injured, the Weber B injury may be either stable
      or unstable. When the ankle is subluxed or dislocated in these injuries, the ankle is clearly
      unstable. However, when the ankle is not initially subluxed, the assessment of stability is
      more difficult. Stability in isolated lateral malleolar fractures depends upon the status of
      the medial, or deltoid, ligaments. Further complicating matters, the deltoid ligament may be
      intact, partially torn, or completely torn such that there is a spectrum of stability for
      these injuries.Previous studies relied upon an assessment of tenderness over the ligament to
      determine instability, but this may not differentiate between partial and complete tears.

      In North America, most surgeons would agree that markedly unstable definitely unstable ankle
      fractures are best treated surgically.Therefore, Weber B fractures which involve fractures of
      both the medial and lateral malleolus are best treated by surgical stabilization.
      Furthermore, Weber B fractures involving only the lateral malleolus, but which present with
      lateral subluxation of the talus, are definitely unstable and require fixation.

      In contrast, controversy exists between surgeons regarding the optimal means of treating an
      undisplaced but potentially unstable fibula fracture. Many surgeons recommend routine
      operative fixation, while others recommend routine non-operative treatment.A clear rationale
      exists for both types of treatment.

      The most important factor in treatment includes maintaining the reduction of the talus within
      the ankle mortise. Even 1 mm of displacement or lateral shift of the talus will affect ankle
      joint loading and lead to dysfunction and potentially arthritis. Other issues include the
      potential benefits of earlier mobilization and rehabilitation.
    

Intervention name(s): non operative treatment; operative treatment of ankle fractures
Intervention type(s): Procedure; Procedure
Intervention description(s): non operative treatment -casting for 6 weeks; operative treatment of ankle fractures
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: undisplaced ,unstable wEBER B ankle fractures; operative intervention; non operative intervention