الفهرس 
Operative versus non-operative treatment of stable Weber type B ankle fractures with an intact syndesmosis
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Abstract
Background:Weber type B fibula fractures are the most common type of ankle fractures. The aim of this study was to compare surgical and non-surgical management of non- or minimally-displaced stable Weber B ankle fractures regarding functional and radiological outcomes
Materialsand methods:This was a prospective randomized controlled trialinvolving 58 patients with stable isolated Weber B fractures with intact syndesmosis, in which stability was determined by Weight-bearing stress radiographs. Patients were randomized by sequentially numbered, opaque, sealed envelopes (SNOSE technique)to group A(operative treatment with open reduction and internal fixation by a 1/3 tubular plate) or group B (non-operative treatment with below-knee cast), including 29 patients in each group. Primary outcome analysis included AOFAS score at 6-months follow-up for functional outcome. Secondary outcome analysis included EQ-5D-5L questionnaire at 6-months for health status/functional outcome, in addition to a 3-weely radiographic assessment for radiological outcome. There were no statistical differences between the two groups with respect to functional and radiological outcomes at 6 months follow-up.
Results:There were no significant differences identified between surgical and non-surgical management of Weber B fractures with respect to functional outcome; the mean AOFAS score at the end of the follow up (at 6 months) was (97.93 ± 4.123) for the operative group and (97.24 ± 4.549) for the conservative group (p-value= 0.548). With respect to quality of life(QoL), this study identified no differences between surgical and non-surgical management. Radiological union was significantly earlier with the operative group, however, at 6 months, both groups showed fully radiologically united fibula on plain radiographs.
Conclusion:Non-operative management is comparable to operative management in such type of fracture regarding functional and radiological outcomes at 6 months; the two groups showed nearly equal results. Consequently, when deciding the optimal intervention for patients with such injuries it is important to consider individual surgeons experience alongside the evidence regarding other outcomes such as effects and cost. A conversation regarding treatment options should be held with the patient