Long-term outcome in operatively and non-operatively treated isolated type B fibula fractures

Leeuwen, C.A.T. van; Hoffman, Ryan; Hoogendoorn, J. M.

doi:10.1016/j.injury.2019.10.006

Cited by 12 publications

(16 citation statements)

References 27 publications

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“…Even though the malunion rate was also higher, this seems to have a negligible effect on the functional outcome in elderly patients [21] . Similar results have been reported by van Leeuwen et al who retrospectively investigated conservative and operative treatment of isolated trans-syndesmotic (type B) fibula fractures [24] . In total, 229 patients were long-term followed up, subdivided in non-operatively treated cohort ( n = 130) and an operatively treated cohort ( n = 99).…”

Section: Ankle Fracturessupporting

confidence: 88%

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Surgical enhancement of fracture healing – operative vs. nonoperative treatment

Baertl

Alt

Rupp

2021

Injury

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Although the success story of surgical fracture treatment led to a tremendous improvement of treatment outcome for certain fractures such as femur or tibia shaft fractures, the overall benefit of surgical versus conservative treatment remains controversial for several types of fractures. For this sake, we carried out a narrative review of high-level of evidence studies comparing treatment outcomes in fractures with controversial debates on the value of surgical therapy in clavicle, proximal humerus, olecranon, ankle, calcaneus and Jones fractures. We identified eight studies (Level-I and -2) with functional and quality of life outcomes in these fractures.Only in Jones fractures of the fifth metatarsal bone, bone healing and functional outcomes were significantly better after surgical compared to conservative treatment. In terms of patient-related quality of life, surgical treatment was not found to be superior compared to conservative treatment in all the above-mentioned fractures. In many trials, lower nonunion rates after surgical treatment were offset by complications due to the surgical procedure. Nonunion after conservative treatment often seemed to have only limited impact on functional results. However, the comparability of studies was limited due to age-differences between patients. Therefore, we emphasize the need for further investigations to determine which patient-related factors favor a conservative treatment approach and for whom surgery is the best option.

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Section: Ankle Fracturessupporting

confidence: 88%

“…Metal removal was necessary in almost 35% after initial surgical treatment. Thus, in the case of a questionable instability, gravity stress radiographs are recommended so that surgery can be avoided in stable fractures [24]. Comparing base line characteristics, operatively treated patients were significantly younger.…”

Section: Ankle Fracturesmentioning

confidence: 99%

Surgical enhancement of fracture healing – operative vs. nonoperative treatment

Baertl

Alt

Rupp

2021

Injury

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“…A growing body of the literature supports treating stable ILMFs non-operatively [ 2 , 8 – 11 ]. Surgical fixation of ILMFs carries a risk of severe AEs and many patients will require subsequent implant removal procedures [ 6 , 12 ]. In clinical practice, many orthopedic surgeons continue to use the degree of fibular fracture displacement as an indication for surgery [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

“…Surgical fixation of ILMFs carries a risk of severe AEs and many patients will require subsequent implant removal procedures [ 6 , 12 ]. In clinical practice, many orthopedic surgeons continue to use the degree of fibular fracture displacement as an indication for surgery [ 12 , 13 ]. A survey study showed that 91% of the responding surgeons stated fibular displacement as critical when deciding between surgical and non-operative ILMF treatment [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

“…In clinical practice, many orthopedic surgeons continue to use the degree of fibular fracture displacement as an indication for surgery [ 12 , 13 ]. A survey study showed that 91% of the responding surgeons stated fibular displacement as critical when deciding between surgical and non-operative ILMF treatment [ 12 ]. Fibular fracture displacement alone does not seem to be a predictor of pathological ankle joint kinematics after injury [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

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Surgical treatment of displaced isolated lateral malleolar fractures: incidence of adverse events requiring revision: a retrospective cohort study

et al. 2022

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Background Recent systematic reviews support that non-operative management should be the standard treatment for all stable isolated lateral malleolar fractures (ILMFs), regardless of fibular fracture displacement. Surgical fixation of ILMFs carries a risk of adverse events (AEs), and many patients will later require implant removal. We wanted to estimate the incidence of AEs requiring revision after surgical fixation of “potentially stable” displaced ILMFs before non-operative treatment became standard care in our department. Materials and methods To identify patients with “potentially stable” ILMFs who had been treated surgically in a historical cohort, we retrospectively applied the stability-based classification system, introduced by Michelson et al., to a cohort of 1006 patients with ankle fractures treated surgically from 2011 to 2016. The primary outcome of this retrospective cohort study was the incidence of AEs that had functionally significant adverse effects on outcome and required revision in the first 12 months after surgery. AEs were graded and categorized using the Orthopedic Surgical Adverse Events Severity (OrthoSAVES) System. Results The study population comprised 108 patients with “potentially stable” displaced ILMFs; 4 patients (3.7% [95% CI (0.1–7.3%]) experienced AEs requiring revision in the first twelve months after surgery. There were 5 additional patients (4.6%) with functionally significant AEs where revision surgery was not indicated within the first twelve months after surgical fixation. A further 5 patients (4.6%) had AEs managed in the outpatient clinic (grade II); 36 patients (33.3%) required secondary implant removal due to implant-related discomfort. Conclusions Surgical fixation of ILMFs carries a risk of severe AEs, and many patients will subsequently need implant-removal procedures. Further prospective studies are required to ascertain whether non-operative treatment can lower the risk of AEs and the need for additional surgical procedures.

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