Surgical versus conservative treatment for ankle fractures in adults - A systematic review and meta-analysis of the benefits and harms.

INTRODUCTION: 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. METHODS: 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. RESULTS: 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, I2=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, I2=0%). CONCLUSIONS: 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.