Hardware Removal After ORIF of Ankle Fractures

Study Overview
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Brief Summary
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Ankle fractures account for 10 % of fractures in the adult population. A part of patients (40%) is treated surgically. After healing of the fractures, about one year after the operation, a surgery is often performed to remove the hardware in order to diminish pain. If this surgery is necessary is debated in the literature. The aim of our study is to evaluate the outcome of hardware removal surgery after a surgery of the ankle for a fracture. For that, we will perform do a controlled randomized trial with two arms: one arm includes the participants who will have a hardware removal and the other arm will not have a surgery. Outcome parameters are the patients reported outcome and pain related disability. They will be assessed by the questionnaires FAAM score (Foot and Ankle Ability Measure) and PDI (Pain Disability Index) at the beginning and at the end of the study, at six months. The third outcome parameter will be the complication rate after an anklehardware removal surgery, which will be assessed through the Ernst-Ssink classification.

Detailed Description
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The study consists of a prospective multicentric parallel two-arm randomised non-blinded study, conducted at the HFR and RHNe (level of evidence II). The planned intervention is the following: after an ORIF of the ankle, patients have a follow-up. At the 12- month control, we ask eligible patients if they want to participate to the study. If they agree, they are randomised to treatment recommendations in one of two groups: conservative or surgical. The patients may follow or not the recommendations; not following the recommendations does not exclude them from the study. Patients of both groups will fill out FAAM and PDI questionnaires at 12 and 18 months after the 1st operation. Patients in the surgical group will have a hardware removal surgery. It is a very common operation consisting of hardware removal that is done ambulatory by the orthopaedic surgeons specialized in foot and ankle surgery. Operated patients will have the usual postoperative follow-up (6 weeks, 3 months and 6 months postoperative) and all complications will be recorded and classified according to the Ernst-sink classification

Official Title
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Hardware Removal After ORIF of Ankle Fractures: A Randomized Trial

Conditions
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Ankle Fractures

Intervention / Treatment
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* Procedure: Hardware removal


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: >18 y.o Operative treatment of ankle/foot fractures at HFR or RHNe: Ankle fractures: bi-malleolar and tri-malleolar fractures or equivalent FAAM score >5%, <95% Patient expected to complete length of study Patient with sufficient cognitive and linguistic ability in order to participate in the study. Operable patients (ASA score ≤3) Exclusion Criteria: Absolute indications for HR: infection/malunion/allergy to metal/refracture Ankle fractures that are not listed in the criteria above Patient treated for a fracture at the same foot/ ankle before Patient with fracture of two different regions of the foot/ankle Patient treated for the fracture outside of HFR and RHNe Patient non ambulating before time of injury Patients having diabete, immunocompromised under chemotherapy, Peripheral artery disease stade IV Pregnant patients

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Hardware removal<br>hardware removal | Procedure: Hardware removal<br>* The surgery of hardware removal after an ORIF of an ankle fracture<br>|
| No Intervention: hardware retaining<br>Patients that retain their hardware | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| patient reported outcome after an ankle hardware removal | FAAM score (Foot and Ankle Ability Measure). FAAM subdivided in AVQ scale(84 points) and Sport scale (32 points). The higher is a better outcome. | 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| pain-related disability after an ankle hardware removal | PDI (Pain Disability Index). Total of 70 points. The higher means a worse outcome. | 6 months | 
| complication rate after an ankle hardware removal surgery | Ernst-sink classification | 6 months |