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Abstract
Isolated type-B ankle fractures with no injury to the medial side (minimal talar shift) are the most common type of ankle fracture. Patient with these types of fractures can be treated surgically with plates and screws or non-surgically in a brace. A systematic review identified a lack of good quality RCTs evaluating this problem.
A retrospective study to determine the longer-term outcomes of surgically vs. non-surgically managed patients with this type of ankle fracture demonstrated that patients treated surgically had a significantly lower patient-reported ankle function when compared with non-surgical management.
An RCT with an observational component was then conducted to evaluate the efficacy of surgical vs. non-surgical management of this common type of fracture. This showed that patient treated surgically did not have significantly better patient reported outcomes when compared with patients treated non-surgically at 12 months.
A systematic review combined the results from two RCTs that and showed that there was no significant difference between patients treated operatively vs. non-operatively with respect to these fractures.
There are many factors that can influence patient participation in an RCT. An observational study of patient factors that influenced participation in a trial comparing surgery to a non-surgical treatment approach was evaluated. This results showed that patient concern about receiving treatment by chance and a strong preference for a particular type of treatment results in non-participating in an RCT.
The major conclusions are that surgical treatment is not superior than non-surgical management for Type B ankle fractures with minimal talar shift. Longer-term follow-up and more good quality RCTs are needed to further evaluate this. Additionally addressing patient concerns about random nature of allocation assignment and treatment preference can improve recruitment in RCTs