Surgical versus non-surgical management of type B ankle fractures with minimal talar shift in adults: a systematic review.

BACKGROUND: This systematic review aims to determine the effectiveness of surgical and non-surgical management for the type B ankle fracture with minimal talar shift.

METHODS: Two authors independently systematically searched the following databases: MEDLINE, EMBASE and CENTRAL. Only randomized controlled trials were included that evaluated surgical versus non-surgical management of type B ankle fracture with minimal talar shift in adults. Two authors independently performed study selection, risk of bias assessment and data extraction. Main outcomes extracted were general health and ankle function. Heterogeneity was assessed using I2 and chi-squared statistic. Data were pooled using fixed effect where appropriate.

RESULTS: Two studies were included involving 241 patients. The pooled mean difference for the physical component score was 0.60 (95% confidence interval (CI): -1.62 to 2.82) non-significantly favouring surgical management. One study reported no significant difference in ankle function (mean difference: 3.20; 95% CI: -6.56 to 12.96) whilst the other reported a significant difference favouring non-surgical management (mean difference: 3.20; 95% CI: 0.44-5.96). Ankle function scores were not pooled due to heterogeneity. Meta-analysis showed that the surgical group was more likely to develop a minor infection (odds ratio: 12.46; 95% CI: 2.29-67.78) or undergo hardware removal (odds ratio: 4.40; 95% CI: 1.09-17.84). There was no significant difference in major infection between the two groups (odds ratio: 4.03; 95% CI: 0.44-36.65; favouring non-surgical management).

CONCLUSION: There was no significant difference in the general health outcome or ankle function for patients treated surgically versus non-surgically at 12 months. Further follow-up is needed to evaluate longer-term ankle function.