Primary outcome measures used in interventional trials for ankle fractures: a systematic review

McKeown, Rebecca; Rabiu, Abdul-Rasheed; Ellard, David R; Kearney, Rebecca S.

doi:10.1186/s12891-019-2770-2

Cited by 20 publications

(15 citation statements)

References 37 publications

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“…To further upgrade the success rate, theoretically the stability should be authentically distinguished. Or, after conservative treatment is nished and the ankle is still unstable, progressive degeneration will be unavoidable [2,30,31].…”

Section: Discussionmentioning

confidence: 99%

“…Ankle injuries are common in the daily activity. Clinically, most of ankle injuries are not severe and usually can be treated with various non-surgical methods with a success [1,2]. Because of the unfavorable bony structures (the huge distal tibia with the small lateral malleolus), the stresses transfer inside the ankle is relatively unsmooth [3,4].…”

Section: Introductionmentioning

confidence: 99%

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Research The Representativeness of An Isolated Medial Malleolar Fracture

Wu¹,

Yeh²,

Lee³

et al. 2020

Preprint

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Background: An isolated medial malleolar fracture (IMMF) is relatively uncommon.Not only is the treatment principle undetermined well, but also is the patho-mechanism debatable. The goal of this retrospective study intended to clarify the patho-mechanism of an IMMF and develop an optimal treatment principle to upgrade a success rate.Methods: For the 10-year period, 59 consecutive adult patients (average, 38 years; range, 18-77 years) with an IMMF were treated. The causes included 42.4% of motorcycle accidents, 20.3% of working injuries, 10.2% of car accidents, 10.2% of slide injuries, and 16.9% of others. The 59 injuries were classified to 59.3% of stage 1 pronation-external rotation (PE), 20.3% of stage 2 PE, 10.2% of stage 2 pronation-abduction (PA), and 10.2% of stage 2 supination-adduction (SA) injuries. Unstable fractures which comprised stage 2 PA and stage 2 SA injuries were treated with internal fixation. Stable fractures which comprised stage 1 PE and stage 2 PE injuries were treated with either internal fixation or conservative techniques.Results: Fifty patients (84.7%, 50 / 59) were followed for at least one year (average, 1.3 years; range, 1-3.1 years). Forty-nine fractures healed with a union rate of 98%. Satisfactory ankle function was achieved in 84% of patients (42 / 50). Four out of eight patients with an unsatisfactory ankle function sustained syndesmotic diastasis. One fracture which was treated with internal fixation sustained screw breakage with nonunion. This patient also had unsatisfactory ankle function.Conclusion: Not all IMMFs can be treated conservatively. Practically, an IMMF should be classified into a stable or unstable type based on radiographs and clinical stress tests. A stable type may include 80% of IMMFs which may be treated with either surgical or conservative techniques. An unstable type may include 20% of IMMFs which had better be treated with internal fixation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Research The Representativeness of An Isolated Medial Malleolar Fracture

Wu¹,

Yeh²,

Lee³

et al. 2020

Preprint

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“…The Olerud-Molander Ankle Score is a validated functional outcome questionnaire leading to a score ranging from 0 to 100, with 0 being the worst possible outcome and 100 the best (without decline in functionality). 6,18,22 The visual analog scale for pain ranged from 0 (no pain) to 10 (worst pain imaginable). 3 After a period of 3 weeks, all patients who did not respond to the questionnaire were contacted by phone.…”

Section: Methodsmentioning

confidence: 99%

The Value of Additional Gravity Stress Radiographs for Decision Making in the Treatment of Isolated Type B Distal Fibular Fractures

et al. 2021

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Background: Prior to treatment decisions concerning isolated Weber type B ankle fractures, assessment of the stability of the ankle joint is mandatory. The gravity stress (GS) radiograph is a radiographic tool to determine stability. We hypothesized that this additional GS radiograph would lead to fewer operative treatments by applying the criterion of operative treatment when medial clear space (MCS) > superior clear space (SCS) + 2 mm on the GS radiograph, compared with the nonstressed mortise view criteria of advising operative treatment in case of MCS > SCS + 1 mm. Methods: This retrospective comparative cohort study analyzed 343 patients aged between 18 and 70 years with an isolated Weber type B ankle fracture diagnosed at the emergency department between January 2014 and December 2019. The cohort was divided into 2 groups based on whether an additional GS radiograph was performed. Group I consisted of 151 patients in whom a regular mortise and lateral radiograph were performed. Group II comprised 192 patients, with an additional GS radiograph. Primary outcome was type of treatment (conservative vs operative). Secondary outcomes were patient-reported functional outcomes and pain. Results: Baseline characteristics of both groups did not differ. In group I, surgery was performed in 60 patients (39.7%) compared with 108 patients (56.3%) in group II ( P = .002). In the operatively treated patients, the mean MCS on regular mortise view was significantly smaller in patients in whom an additional GS radiograph was performed compared to patients without an additional GS radiograph (4.1 mm vs 5.2 mm, P < .001). Mean Olerud-Molander Ankle Score and mean visual analog scale (VAS) for pain did not differ significantly between groups I and II. Conclusions: Contrary to what was hypothesized, the introduction of an additional gravity stress radiograph, by which operative treatment was indicated if the MCS was wider than the SCS + 2 mm, did not result in reduced operative treatment of Weber type B ankle fractures when operative treatment was indicated for MCS > SCS + 1 mm on non-gravity stress radiographs. Level of Evidence: Level III: retrospective comparative study.

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“…Ankle injuries are common in the daily activity. Clinically, the majority of ankle injuries are not severe and non-surgical treatment techniques can usually achieve a success [1,2]. However, in some ankle injuries which normally comprise malleolar fractures and syndesmotic diastasis (SD) often require surgical treatment.…”

Section: Introductionmentioning

confidence: 99%

Favored location of a stabilizing screw for syndesmotic diastasis: Recommendation based on clinical and theoretical considerations

Yeh

Lee

et al. 2020

Preprint

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Background Although ankle injuries are common, combined malleolar fractures and syndesmotic diastasis (SD) are relatively fewer. The optimal technique for syndesmotic stabilization has yet achieved consensus. The favored location of a stabilizing screw for SD was investigated clinically and theoretically. Methods For the 10-year period, 63 consecutive adult patients with combined injuries were retrospectively studied. After malleolar fractures were internally stabilized with screws and plates, stress tests were performed to re-confirm syndesmotic instability. The diastatic syndesmosis was stabilized with cortical screws under image intensifier guidance. In the present study, only patients with one syndesmotic screw (55 patients) were enrolled and divided into the trans-syndesmotic (TR) or the supra-syndesmotic (SU) group. Clinical and functional outcomes between the two groups were compared. The favored location was speculated consequently.Results Forty-eight patients were followed for at least one year (average, 1.8 years; range, 1.0-7.0 years). The TR group included 31 patients and the SU group, 17 patients. All clinical and functional comparisons were not statistically significant (p > 0.05). Conclusions Although statistical comparison is insignificant, TR screw insertion possesses biomechanical and biological merits. Unable to reveal advantages of TR screw insertion in clinical and functional comparisons may be imputed to insufficient sample sizes and early screw removal. Practically, TR insertion of a screw with late removal (> 3 months) may be a better choice.

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Primary outcome measures used in interventional trials for ankle fractures: a systematic review

Cited by 20 publications

References 37 publications

Research The Representativeness of An Isolated Medial Malleolar Fracture

Research The Representativeness of An Isolated Medial Malleolar Fracture

The Value of Additional Gravity Stress Radiographs for Decision Making in the Treatment of Isolated Type B Distal Fibular Fractures

Favored location of a stabilizing screw for syndesmotic diastasis: Recommendation based on clinical and theoretical considerations

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