Stockwell Erin, Thomas Phillip, Grossman Leonid, Lyden Elizabeth, Mormino Matthew, Siebler Justin, Putnam Sara
Department of Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, Omaha, NE.
Essentia Health, Duluth, MN.
J Orthop Trauma. 2024 Jan 1;38(1):e20-e27. doi: 10.1097/BOT.0000000000002719.
To determine whether a nonoperative management protocol results in equivalent outcomes in isolated OTA/AO 44B (Weber B) fractures without initial medial clear space (MCS) widening regardless of stress radiography findings.
Prospective cohort.
Level 1 academic trauma center.
Nonoperatively managed patients with isolated OTA/AO 44B fractures and MCS ≤4 mm on initial non-weightbearing injury radiographs between from January 2018 and January 2022 were included. All patients underwent emergency department gravity stress radiographs and those with widening were considered the widening cohort and those without the non-widening cohort.
MCS measurements on weightbearing radiographs were obtained at first follow-up, 6 weeks, 12 weeks, and 6 months postinjury, were considered indicative of instability if >4 mm and were compared between cohorts.; American Orthopaedic Foot and Ankle Society ankle-hindfoot scores were also compared between cohorts.
Sixty-nine patients were studied. None of the 38 patients (55%) with widening on gravity stress radiographs demonstrated widening with weightbearing radiographs at any time point. Mean MCS measurement differences between the 2 cohorts were statistically significant for all time points ( P = 0.012); however, with a model adjusted mean MCS value of 2.7 mm for the nonwidening cohort and 2.9 mm for the widening cohort, these are not clinically significant. There was no statistically significant difference in overall final American Orthopaedic Foot and Ankle Society scores between the 2 groups ( P = 0.451). In addition, statistical equivalence using Schuirmann 2 one-sided tests was achieved between the 2 groups. Both cohorts had mean American Orthopaedic Foot and Ankle Society scores representing excellent outcomes at the final follow-up.
Patients with isolated OTA/AO 44B fractures without MCS widening on initial injury radiographs did not demonstrate instability on subsequent weightbearing radiographs and had equivalent outcomes regardless of gravity stress radiography findings when treated nonoperatively. Weightbearing radiographs at the initial follow-up appear to be a reliable assessment of ankle stability in these injuries and are an appropriate alternative to painful and time-consuming stress radiography.
Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
确定非手术治疗方案对于初始内侧间隙（MCS）未增宽的孤立OTA/AO 44B（Weber B型）骨折，无论应力位X线片结果如何，是否能产生等效的治疗效果。
前瞻性队列研究。
一级学术创伤中心。
纳入2018年1月至2022年1月期间因孤立OTA/AO 44B骨折接受非手术治疗且初始非负重损伤X线片上MCS≤4mm的患者。所有患者均在急诊科进行重力应力位X线片检查，MCS增宽者纳入增宽队列，未增宽者纳入未增宽队列。
在伤后首次随访、6周、12周和6个月时获取负重位X线片上的MCS测量值，若>4mm则提示不稳定，并在队列间进行比较；同时在队列间比较美国矫形足踝协会（American Orthopaedic Foot and Ankle Society）踝-后足评分。
共研究69例患者。38例（55%）重力应力位X线片显示增宽的患者在任何时间点的负重位X线片上均未出现增宽。两个队列在所有时间点的平均MCS测量值差异均有统计学意义（P = 0.012）；然而，未增宽队列的模型校正平均MCS值为2.7mm，增宽队列的为2.9mm，这些差异无临床意义。两组最终的美国矫形足踝协会总体评分无统计学差异（P = 0.451）。此外，两组间采用Schuirmann双侧单侧检验达到了统计学等效性。两个队列在最终随访时的美国矫形足踝协会平均评分均代表优良结果。
初始损伤X线片上MCS未增宽的孤立OTA/AO 44B骨折患者，非手术治疗时，后续负重位X线片未显示不稳定，且无论重力应力位X线片结果如何，治疗效果相当。首次随访时的负重位X线片似乎是评估这些损伤时踝关节稳定性的可靠方法，可以替代痛苦且耗时的应力位X线片。
治疗性II级。有关证据水平的完整描述，请参阅《作者须知》。
