TY - JOUR
T1 - Surgical Versus Conservative Treatment For Ankle Fractures In Adults
T2 - A systematic review and meta-analysis of the benefits and harms
AU - Larsen, Peter
AU - Rathleff, Michael S.
AU - Elsoe, Rasmus
PY - 2019/8
Y1 - 2019/8
N2 - Introduction: Despite fractures of the ankle being very common, there is a lack of clarity regarding the relative effectiveness of conservative versus surgical treatment. The purpose of this systematic review and meta-analysis was to investigate the clinical effects, benefits, and harms of surgical versus conservative treatment of ankle fractures in adults. Methods: A systematic search strategy was conducted in the databases: Pubmed, Embase, Web of Science, and Cochrane up until the 16th of August 2017. Eight available randomized controlled trials, regardless of fracture type, reported on patient-reported ankle-specific functional outcome and were included. Analyses were based on random effects models. Results: The 8 included studies randomly allocated 1237 patients to either surgical or conservative treatment. Mean age of patients ranged from 38.1 to 71.4 years. Five studies evaluated short-term patient-reported ankle function, with no significant difference between surgery and conservative treatment (SMD = −0.14, 95%CI = −0.57 to 0.29, P = 0.51, I
2 = 84%). Three studies evaluated health-related quality of life, with no significant difference in treatment effect between surgery or conservative treatment (SMD = 0.13, 95%CI = −0.01 to 0.27, P = 0.06, I
2 = 0%). Conclusions: The best available current evidence supports that clinicians can manage ankle fractures by both surgical and conservative means with equal short-term results in selected patient groups with stable and unstable nondisplaced ankle fractures. However, more research is needed including high-quality RCTs investigating the long-term effects. This is especially the case in younger patients, before making significant interpretations about clinical practice.
AB - Introduction: Despite fractures of the ankle being very common, there is a lack of clarity regarding the relative effectiveness of conservative versus surgical treatment. The purpose of this systematic review and meta-analysis was to investigate the clinical effects, benefits, and harms of surgical versus conservative treatment of ankle fractures in adults. Methods: A systematic search strategy was conducted in the databases: Pubmed, Embase, Web of Science, and Cochrane up until the 16th of August 2017. Eight available randomized controlled trials, regardless of fracture type, reported on patient-reported ankle-specific functional outcome and were included. Analyses were based on random effects models. Results: The 8 included studies randomly allocated 1237 patients to either surgical or conservative treatment. Mean age of patients ranged from 38.1 to 71.4 years. Five studies evaluated short-term patient-reported ankle function, with no significant difference between surgery and conservative treatment (SMD = −0.14, 95%CI = −0.57 to 0.29, P = 0.51, I
2 = 84%). Three studies evaluated health-related quality of life, with no significant difference in treatment effect between surgery or conservative treatment (SMD = 0.13, 95%CI = −0.01 to 0.27, P = 0.06, I
2 = 0%). Conclusions: The best available current evidence supports that clinicians can manage ankle fractures by both surgical and conservative means with equal short-term results in selected patient groups with stable and unstable nondisplaced ankle fractures. However, more research is needed including high-quality RCTs investigating the long-term effects. This is especially the case in younger patients, before making significant interpretations about clinical practice.
KW - Ankle fracture
KW - Conservative
KW - Surgical
KW - Treatment
UR - http://www.scopus.com/inward/record.url?scp=85043243702&partnerID=8YFLogxK
U2 - 10.1016/j.fas.2018.02.009
DO - 10.1016/j.fas.2018.02.009
M3 - Review article
SN - 1268-7731
VL - 25
SP - 409
EP - 417
JO - Foot and Ankle Surgery
JF - Foot and Ankle Surgery
IS - 4
ER -