dc.date.accessioned | 2024-03-25T17:45:02Z | |
dc.date.available | 2024-03-25T17:45:02Z | |
dc.date.created | 2023-11-07T10:39:59Z | |
dc.date.issued | 2023 | |
dc.identifier.citation | Gregersen, Martin Robinson, Hilde Stendal Molund, Marius . Concomitant Unstable and Stable Gravity Stress Tests on Weight-Bearing Stable Weber B Ankle Fractures Treated Nonoperatively: A 2-Year Outcome Study. Journal of Bone and Joint Surgery. American volume. 2023, 105(18), 1435-1441 | |
dc.identifier.uri | http://hdl.handle.net/10852/110127 | |
dc.description.abstract | Background:
Replacing gravity stress tests with weight-bearing radiographs to evaluate the stability of Weber B (also called Lauge-Hansen supination-external rotation [SER]) ankle fractures results in a lower surgery rate, thus avoiding associated risks and complications. Still, nonoperative treatment of weight-bearing stable fractures is controversial because of the scarcity of strong evidence. We investigated the influence of a concomitant unstable gravity stress test compared with a stable gravity stress test on outcomes after nonoperative treatment of weight-bearing stable fractures.
Methods:
We performed a prospective, noninferiority study on 149 patients with Weber B ankle fractures and stable weight-bearing radiographs. Gravity stress radiographs classified fractures as stable (SER2 [n = 88]) or partially unstable (SER4a [n = 61]). All were treated with a functional orthosis and weight-bearing was allowed; patients were followed for 2 years. The primary outcome was the Manchester-Oxford Foot and Ankle Questionnaire (MOXFQ), with a range from 0 to 100, in which lower scores indicate fewer symptoms. A noninferiority margin was prospectively defined as 7.5 points. The secondary outcomes included the Olerud-Molander Ankle Score, assessment of ankle congruence, and treatment-related adverse events.
Results:
The primary outcome data were available for 144 (96.6%) of 149 participants at 2 years. The between-group difference in the MOXFQ score was 1.0 point (95% confidence interval, −1.4 to 3.4 points; p = 0.397) in favor of the SER2 group, consistent with noninferiority. We found no appreciable between-group differences for any other outcome.
Conclusions:
In Weber B/SER ankle fractures that are stable on weight-bearing radiographs, are treated with removable orthoses, and are allowed to bear weight, a concomitant unstable gravity stress test (SER4a) was not associated with worse patient-reported or radiographic outcomes compared with a stable gravity stress test (SER2) at the 2-year follow-up. Thus, the identification of stress instability seems redundant, which questions the applicability of stress instability for surgical decision-making.
Level of Evidence:
Diagnostic Level II . See Instructions for Authors for a complete description of levels of evidence. | |
dc.language | EN | |
dc.rights | Attribution-NonCommercial-NoDerivatives 4.0 International | |
dc.rights.uri | https://creativecommons.org/licenses/by-nc-nd/4.0/ | |
dc.title | Concomitant Unstable and Stable Gravity Stress Tests on Weight-Bearing Stable Weber B Ankle Fractures Treated Nonoperatively: A 2-Year Outcome Study | |
dc.title.alternative | ENEngelskEnglishConcomitant Unstable and Stable Gravity Stress Tests on Weight-Bearing Stable Weber B Ankle Fractures Treated Nonoperatively: A 2-Year Outcome Study | |
dc.type | Journal article | |
dc.creator.author | Gregersen, Martin | |
dc.creator.author | Robinson, Hilde Stendal | |
dc.creator.author | Molund, Marius | |
cristin.unitcode | 185,52,10,0 | |
cristin.unitname | Avdeling for tverrfaglig helsevitenskap | |
cristin.ispublished | true | |
cristin.fulltext | original | |
cristin.qualitycode | 2 | |
dc.identifier.cristin | 2193082 | |
dc.identifier.bibliographiccitation | info:ofi/fmt:kev:mtx:ctx&ctx_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.jtitle=Journal of Bone and Joint Surgery. American volume&rft.volume=105&rft.spage=1435&rft.date=2023 | |
dc.identifier.jtitle | Journal of Bone and Joint Surgery. American volume | |
dc.identifier.volume | 105 | |
dc.identifier.issue | 18 | |
dc.identifier.startpage | 1435 | |
dc.identifier.endpage | 1441 | |
dc.identifier.doi | https://doi.org/10.2106/JBJS.23.00195 | |
dc.type.document | Tidsskriftartikkel | |
dc.type.peerreviewed | Peer reviewed | |
dc.source.issn | 0021-9355 | |
dc.type.version | PublishedVersion | |