Surgical versus conservative management of ankle fractures in adults: A systematic review and meta-analysis.

Abstract

AIMS:

This study compared outcomes of surgical versus conservative management of ankle fractures in adults through a systematic review and meta-analysis.

METHODS:

We searched CINAHL, EMBASE, MEDLINE and CENTRAL databases (1946-June 2019) for randomised and quasi-randomised controlled trials comparing surgical versus conservative management of closed adult ankle fractures of any type. Estimates of effect were pooled using random effects meta-analysis.

RESULTS:

1153 patients from 7 trials were included. Our primary outcome, ankle function score, was not statistically significantly different at 6-months (pooled mean difference (surgical minus conservative) = 1.0; 95% CI: -2.3 to 4.3; p = 0.55) or 12-months or more (pooled mean difference = 4.6; 95% CI: -1.0 to 10.2; p = 0.11) between surgical and conservative groups in three trials assessing displaced or unstable fractures, and two trials using non-validated questionnaires. One trial assessing AO-type-B1 fractures without talar shift had a statistically significant difference favouring conservative management, which was not clinically meaningful. Surgery had lower rates of early treatment failure and malunion/non-union, but higher rates of further surgery and infection.

CONCLUSIONS:

Surgical and conservative management of displaced or unstable ankle fractures produce similar short-term functional outcomes. The higher risk of early treatment failure and malunion/non-union in the conservative group versus higher rates of further surgery and infection in the surgical group should be considered. Trials are needed to assess longer-term results and inform management of select patient groups.

• Authors: Omar A Javed, Qasim A Javed, Obioha C Ukoumunne, Livio Di Mascio
• Journal: Foot and ankle surgery : official journal of the European Society of Foot and Ankle Surgeons (Foot Ankle Surg) Vol. 26 Issue 7 Pg. 723-735 (Oct 2020) ISSN: 1460-9584 [Electronic] France
• PMID: 31818542 (Publication Type: Journal Article, Meta-Analysis, Systematic Review)
• Copyright: Copyright © 2019 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

Topics

• Ankle Fractures (therapy)
• Bandages
• Conservative Treatment (methods)
• Fracture Fixation (methods)
• Humans
• Treatment Outcome