Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, Aalborg, Denmark.
Department of Orthopedic Surgery, Aalborg University Hospital, Aalborg, Denmark.
Foot Ankle Surg. 2019 Aug;25(4):409-417. doi: 10.1016/j.fas.2018.02.009. Epub 2018 Mar 1.
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.
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.
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=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=0%).
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.
尽管踝关节骨折非常常见，但对于保守治疗与手术治疗的相对效果仍存在一些不明确之处。本系统评价和荟萃分析旨在调查成人踝关节骨折的手术与保守治疗的临床效果、益处和危害。
系统检索了 Pubmed、Embase、Web of Science 和 Cochrane 数据库，检索时间截至 2017 年 8 月 16 日。共纳入 8 项随机对照试验，无论骨折类型如何，均报告了患者报告的踝关节特异性功能结局。分析基于随机效应模型。
8 项纳入研究将 1237 例患者随机分配至手术或保守治疗组。患者的平均年龄为 38.1-71.4 岁。5 项研究评估了短期患者报告的踝关节功能，手术与保守治疗之间无显著差异（SMD=-0.14，95%CI=-0.57 至 0.29，P=0.51，I²=84%）。3 项研究评估了健康相关生活质量，手术与保守治疗之间的治疗效果无显著差异（SMD=0.13，95%CI=-0.01 至 0.27，P=0.06，I²=0%）。
目前最佳证据表明，对于稳定和不稳定非移位踝关节骨折的特定患者群体，临床医生可以通过手术和保守治疗来管理踝关节骨折，两种方法在短期结果方面相当。但是，需要开展更多研究，包括高质量 RCT 研究，以调查长期效果。特别是在年轻患者中，在对临床实践做出重要解释之前，需要开展更多研究。
