Influence of Patient-Reported Outcome Measures by Surgical Versus Conservative Management in Adult Ankle Fractures: A Systematic Review and Meta-Analysis

Operative vs. Nonoperative Management of Isolated Weber B Ankle Fractures

Background and objective Ankle fractures (AFs) are common in orthopedic practice, with Weber B fractures representing a significant proportion. These fractures occur at the syndesmotic level of the fibula and can be treated either operatively or nonoperatively. However, the optimal management approach remains debated, particularly for isolated fractures without medial or syndesmotic involvement. This study aims to compare the operative and nonoperative management outcomes of isolated Weber B AFs in terms of functional recovery, complication rates, and patient satisfaction. Methodology This retrospective cohort study was conducted at the Department of Orthopedics, Hayatabad Medical Complex, Peshawar, from February 3, 2022, to March 2, 2023. A total of 115 patients with isolated Weber B AFs were included. Patients were categorized into operative (n = 65, 56.5%) and nonoperative (n = 50, 43.5%) groups. Outcomes assessed at six months included functional recovery using the Olerud-Molander Ankle Score (OMAS), complication rates (e.g., malunion, nonunion, and infection), and patient satisfaction levels. Statistical analyses were performed to compare outcomes between groups. Results The operative group demonstrated significantly higher OMASs (89.2 ± 6.3) than the nonoperative group (81.4 ± 8.1, P = 0.009). Malunion occurred in 4 patients (8%) in the nonoperative group but was not observed in the operative group (P = 0.034). Surgical site infections were observed in 3 patients (4.6%) in the operative group. Patient satisfaction was higher in the operative group, with 49 patients (75.3%) reporting being very satisfied compared to 32 patients (64%) in the nonoperative group (P = 0.045). Conclusions Operative management of isolated Weber B fractures offers better functional recovery and a lower risk of malunion compared to nonoperative treatment. For stable fractures, nonoperative management remains a valid option. Further long-term studies are required to assess the durability of outcomes for both approaches.

Study on the risk factors of postoperative wound complications in patients with ankle fracture

Wound complications after surgery for ankle fractures can lead to catastrophic consequences. The purpose of this study was to evaluate the risk factors of postoperative wound complications in patients with ankle fracture and to determine their effects on prognosis. 200 patients with ankle fracture treated in our hospital from October 2021 to December 2023 were analysed retrospectively. The total incidence of postoperative wound complications was 19% (38/200). Type of complications: wound edge necrosis 15 cases (39.47%), dehiscence (reopening of wound) 13 cases (34.21%), delayed healing (>30 days) 10 cases (26.32%); Univariate analysis showed that patients' age, body mass index (BMI), current smoking, alcoholism, diabetes mellitus, injury mechanism, open fracture, wound classification, higher American Society of Anesthesiologists (ASA) score and operation time were all associated with postoperative wound complications. Multivariate Logistic regression model shows: age ≥60 years old OR3.671 (1.875-5.937), BMI OR1.198 (1.143-1.324), current smoking OR2.727 (1.251-5.602), alcoholism OR1.143 (1.034-1.267), complicated with diabetes OR2.763 (1.236-4.852), injury mechanism (high vs. low and medium energy) OR2.437 (1.238-4.786), open fracture OR1.943 (1.8262.139), wound classification (II vs. I) OR4.423 (1.73511.674), ASA score (III-IV vs. I-II) OR1.307 (1.113-2.194) was an independent risk factor for postoperative wound complications in patients with ankle fracture. Further, ROC curves showed that these nine independent influences had high accuracy and validity in predicting postoperative wound complications in patients with ankle fractures. In conclusion, independent risk factors for postoperative complications of ankle fracture were age >60 years, BMI, injury mechanism, open fracture, wound classification (II vs. I), ASA score, current smoking, and alcoholism. The wound classification (II vs. I) has the highest diagnostic value.

Spanish Translation, Cross-Cultural Adaptation, and Validation of the Olerud-Molander Ankle Score (OMAS) for Ankle Fractures

Background

The aim of this study was to translate and cross-culturally adapt the Olerud-Molander Ankle Score (OMAS) into Spanish and to assess its reliability and validity.

Methods

The translation and adaptation to develop the Spanish version of the OMAS (OMAS-Sp) was performed according to current international guidelines. The OMAS-Sp was administered to 98 patients with a surgically treated ankle fracture, and it was repeated 7-14 days later to assess construct reliability of each question's score and the total score. Test-retest reliability and the internal consistency were calculated, and concurrent validity was assessed by comparing the OMAS-Sp with the Foot and Ankle Outcome Score (FAOS). The presence of floor and ceiling effects was also analyzed.

Results

Adequate internal consistency was found with a Cronbach α of 0.821. Excellent test-retest reliability was demonstrated with an interclass correlation coefficient for the total score of 0.970 (95% CI 0.956-0.980; P < .001). Spearman correlation coefficients (r's) between the OMAS-Sp total score and the 5 FAOS subscales ranged from 0.944 to 0.951 (P < .001). No floor or ceiling effects were found.

Conclusion

The OMAS-Sp demonstrated adequate psychometric properties and is a valid and reliable tool for assessing outcomes in Spanish-speaking patients with surgically treated ankle fractures.

Level of Evidence

Level II, prospective cohort study.