In clinical practice, many orthopedic surgeons continue to use the degree of fibular fracture displacement as an indication for surgery. Surgical fixation of ILMFs carries a risk of severe AEs and many patients will require subsequent implant removal procedures. A growing body of the literature supports treating stable ILMFs non-operatively. ILMFs are the most common type of ankle fracture. Our hypothesis was that a substantial proportion of patients with “potentially stable” fractures could have been managed non-operatively if a preoperative stress-test had been performed to determine stability. In this study, we retrospectively applied the stability-based classification system to a cohort of 1006 patients with ankle fractures treated surgically to identify patients with “potentially stable” displaced isolated lateral malleolar fractures (ILMF) according to these stability criteria. According to the stability-based classification, an ankle fracture should be considered stable if it does not require reduction, is unimalleolar, and shows sufficient ligamentous integrity to secure anatomical alignment of the talus under the tibia. describes an algorithm to differentiate unstable ankle fractures, which should be treated surgically, from stable fractures, which should be treated non-operatively. The stability-based classification system by Michelson et al. Further prospective studies are required to ascertain whether non-operative treatment can lower the risk of AEs and the need for additional surgical procedures.ĭiagnosing clinically relevant instability is key when treating isolated lateral malleolar fractures. Surgical fixation of ILMFs carries a risk of severe AEs, and many patients will subsequently need implant-removal procedures. 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. 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. The study population comprised 108 patients with “potentially stable” displaced ILMFs 4 patients (3.7% ) experienced AEs requiring revision in the first twelve months after surgery. AEs were graded and categorized using the Orthopedic Surgical Adverse Events Severity (OrthoSAVES) System. 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. 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. 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. Surgical fixation of ILMFs carries a risk of adverse events (AEs), and many patients will later require implant removal. doi:10.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 treatment of displaced isolated lateral malleolar fractures: incidence of adverse events requiring revision: a retrospective cohort study. Ankle fracture: open reduction and internal fixation. Management of posttraumatic ankle arthritis: literature review.
Ankle fractures (broken ankle).Įwalefo SO, Dombrowski M, Hirase T, et al. doi:10.5435/JAAOS-D-17-00417Īmerican Academy of Orthopedic Surgeons. Management of isolated lateral malleolus fractures. Fractures of the ankle joint: investigation and treatment options. Goost H, Wimmer MD, Barg A, Kabir K, Valderrabano V, Burger C.
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