Response to “Letter Regarding: Weightbearing vs Gravity Stress Radiographs for Stability Evaluation of Supination-External Rotation Fractures of the Ankle”

Seidel, Angela; Krause, Fabian; Weber, Martin

doi:10.1177/1071100717742122

Cited by 2 publications

(5 citation statements)

References 2 publications

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“…We acknowledge the concern for the patients in the non-operative group, but with the increasing evidence supporting weightbearing radiographs as a method of evaluating the patency of the deltoid ligament and thus the stability of the ankle mortise, we are convinced that the rationale behind the present study is justified. [25][26][27][28][29][30][31] Recent studies on weightbearing radiographs of transsyndesmotic fibula fractures have shown that the ankle congruency is preserved after fracture union, and we expect the same results for suprasyndesmotic fractures. 32 We also plan to prolong the follow-up period to 5 and 10 years in order to identify possible later presentations of post-traumatic OA.…”

Section: Discussionmentioning

confidence: 99%

Non-operative versus operative treatment of suprasyndesmotic ankle fractures: protocol for a prospective, multicentre, randomised controlled trial

Saatvedt,

Riiser,

Frihagen

et al. 2024

BMJ Open

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IntroductionSurgery is widely recognised as the treatment of choice for suprasyndesmotic ankle fractures, because of the assumption that these injuries yield instability of the ankle joint. Stability assessment of ankle fractures using weightbearing radiographs is now used regularly to guide the treatment of transsyndesmotic and infrasyndesmotic ankle fractures. Patients with a congruent ankle joint on weightbearing radiographs can be treated non-operatively with excellent results. Weightbearing radiographs are, however, rarely performed on suprasyndesmotic fractures due to the assumed unstable nature of these fractures. If weightbearing radiographs can be used to identify suprasyndesmotic fractures suitable for non-operative treatment, we may save patients from the potential burdens of surgery.Our aim is to compare the efficacy of operative and non-operative treatment of patients with suprasyndesmotic ankle fractures that reduce on weightbearing radiographs.Methods and analysisA non-inferiority randomised controlled trial involving 120 patients will be conducted. A total of 120 patients with suprasyndesmotic ankle fractures with an initial radiographic medial clear space of <7 mm will be subjected to weightbearing radiographs. If the tibio-talar joint is completely reduced, we will randomise in a 1:1 ratio to either operative treatment including reduction and fixation of the syndesmosis or non-operative treatment with an orthosis. The primary study outcome is patient-reported ankle function and symptoms as measured by the Olerud-Molander Ankle Score at 2-year follow-up. Secondary outcomes include the Manchester-Oxford Foot Questionnaire, range of motion, radiographic results and rates of adverse events.Ethics and disseminationThe Regional Committee for Medical and Health Research South East, group A (permission number: 169307), has granted ethics approval. The results of this study will provide valuable insights for developing future diagnostic and treatment strategies for a common fracture type. The findings will be shared through publication in peer-reviewed journals and presentations at conferences.Trial registration numberNCT04615650.

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Section: Discussionmentioning

confidence: 99%

Non-operative versus operative treatment of suprasyndesmotic ankle fractures: protocol for a prospective, multicentre, randomised controlled trial

Saatvedt,

Riiser,

Frihagen

et al. 2024

BMJ Open

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“…14 MDC is defined as 4.7 points. 8 Furthermore, we will assess the radiological congruity/stability of injured versus normal ankles at two years. Ankles are considered congruent/stable if the MCS measurement of the injured versus the uninjured ankle is less than 1.0 mm.…”

Section: Secondary Outcomesmentioning

confidence: 99%

“…[1][2][3][4][5] The primary determinant of ankle stability is the competency of the deltoid ligament. [1][2][3]6 Recent studies indicate that partial deltoid ligament injury is common, 2,7,8 determined by weightbearing radiographs deemed stable (no increase in medial clear space), while concomitant gravity stress radiographs demonstrate instability (due to an increase in medial clear space) (Figure 1). It is suggested that this is referred to as a Weber B/SER4a injury, and is due to partial deltoid ligament injury where the deep posterior tibiotalar ligament is intact.…”

Section: Introductionmentioning

confidence: 99%

“…There is debate among authors on the best nonoperative treatment for these fractures, with some advocating for cast immobilization and others reporting successful outcomes using various orthoses and orthotic devices. 2 , 8 The argument for cast immobilization is based on the fear of post-traumatic osteoarthritis due to potential instability, 2 but there is no formal evidence to support this. The British Orthopaedic Association Standards for Trauma recommend cast immobilization for partially unstable fractures, 12 but this approach carries risks such as muscle atrophy, deep vein thrombosis, and joint stiffness.…”

Section: Introductionmentioning

confidence: 99%

“…Although prospective studies have emerged, 7 the evidence is primarily based on retrospective studies with varying follow-up protocols and limited statistical power. [8][9][10][11] No randomized controlled trials (RCTs) have been conducted on this topic.…”

Section: Introductionmentioning

confidence: 99%

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Functional orthosis versus cast immobilization for weightbearing stable Weber B ankle fractures with concomitant unstable gravity stress tests

Gregersen,

Justad-Berg,

Gill

et al. 2023

Bone Jt Open

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AimsTreatment of Weber B ankle fractures that are stable on weightbearing radiographs but unstable on concomitant stress tests (classified SER4a) is controversial. Recent studies indicate that these fractures should be treated nonoperatively, but no studies have compared alternative nonoperative options. This study aims to evaluate patient-reported outcomes and the safety of fracture treatment using functional orthosis versus cast immobilization.MethodsA total of 110 patients with Weber B/SER4a ankle fractures will be randomized (1:1 ratio) to receive six weeks of functional orthosis treatment or cast immobilization with a two-year follow-up. The primary outcome is patient-reported ankle function and symptoms measured by the Manchester-Oxford Foot and Ankle Questionnaire (MOxFQ); secondary outcomes include Olerud-Molander Ankle Score, radiological evaluation of ankle congruence in weightbearing and gravity stress tests, and rates of treatment-related adverse events. The Regional Committee for Medical and Health Research (approval number 277693) has granted ethical approval, and the study is funded by South-Eastern Norway Regional Health Authority (grant number 2023014).DiscussionRandomized controlled trials are needed to evaluate alternative nonoperative treatment options for Weber B/SER4a ankle fractures, as current clinical guidelines are based on biomechanical reasoning. The findings will be shared through publication in peer-reviewed journals and presentations at conferences.Cite this article: Bone Jt Open 2023;4(9):713–719.

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Response to “Letter Regarding: Weightbearing vs Gravity Stress Radiographs for Stability Evaluation of Supination-External Rotation Fractures of the Ankle”

Cited by 2 publications

References 2 publications

Non-operative versus operative treatment of suprasyndesmotic ankle fractures: protocol for a prospective, multicentre, randomised controlled trial

Non-operative versus operative treatment of suprasyndesmotic ankle fractures: protocol for a prospective, multicentre, randomised controlled trial

Functional orthosis versus cast immobilization for weightbearing stable Weber B ankle fractures with concomitant unstable gravity stress tests

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