Surgery does not provide better treatment results in unstable lateral malleolus fractures
Keywords:The SUPER-FIN study, by a research team from University of Oulu, University of Helsinki, and HUS, shows that surgery does not provide better results than cast immobilisation when treating unstable lateral malleolus fractures, which is the most common type of ankle fracture. Instead, surgery increases the risk of treatment related harms. The results were published in the international medical journal The BMJ.
Fractures of the lateral malleolus are the most common type of fracture in the lower extremities. Traditionally, these fractures have been treated with surgery when the fracture has been deemed unstable, even though there has been no solid evidence on its efficiency.
The SUPER-FIN study compared two treatment methods: cast immobilisation for six weeks and surgery. The participating patients were randomised to two groups after a physician assessed their fracture to be unstable with a rotation stress test. The patients’ recovery was monitored for two years.
The most important indicator in the study was the patients’ own assessment of their ankle function and mobility. The results show that cast immobilisation was at least as good as surgical treatment. There were no differences between the two groups in ankle function, amount of pain, patient satisfaction, or recovery as assessed from x-rays. However, the surgical treatment caused clearly more harm, such as wound problems and infections, as well as more consequent treatments.
“When the treatment result is as good without surgery but with less complications, it is reasonable to review the established treatment practises”, says Tero Kortekangas, the study’s principal investigator.
In 2019, the research group already demonstrated that lateral fractures of the ankle can be safely treated with cast immobilisation for three weeks instead of the previously used six weeks. The new results expand this treatment method to also cover fractures that have previously deemed unstable.
“The results suggest that when treating fractures of the lateral malleolus, surgery can be used less often also in situations where it has been considered necessary previously. This improves patient safety and saves healthcare resources”, say Harri Pakarinen and Teppo Järvinen, who lead the research group.
Original publication: Cast immobilisation versus surgery for unstable lateral malleolus fractures (SUPER-FIN): randomised non-inferiority clinical trial | The BMJ