Long-term outcome in operatively and non-operatively treated isolated type B fibula fractures

Type B fibula fractures are the most common type of ankle fractures. Generally, surgical repair is advised for unstable fractures and non-operative treatment for stable fractures. However, evidence on long-term functional outcome of both treatment regimens is lacking. Aim of this study is to compare the long-term outcome in function and pain between patients with an isolated type B fibula fracture treated non-operatively and surgically.

In this retrospective cohort study, all consecutive patients aged between 18 and 75 years, treated non-operatively or surgically between January 2008 and December 2015 for a distal fibula fracture at the level of the syndesmosis without an additional medial or posterior fracture and with a medial clear space ≤6 mm were included. All eligible patients received a questionnaire, composed of the Olerud-Molander Ankle Score (OMAS), the American Orthopaedic Foot and Ankle Society ankle-hindfoot score (AOFAS), the Euroqol-5D (EQ-5D) for quality of life and the Visual Analogue Scale (VAS) for pain sensation. With a mean follow-up of 5.3 years, 229 patients were included. For all aspects of the questionnaire, there was no significant difference between non-operative and operative treatment in outcome of function and pain: the EQ-5D score was respectively 0.8 vs. 0.9 (p = 0.72), mean VAS score 0.8 vs. 1.3 (p = 0.09), OMA score 84 vs. 84 (p = 0.98) and for the AOFAS 93 vs. 90 (p = 0.28). 33% of the patients who had surgery had revision surgery for implant removal because of persistent pain complaints. In 3% of the surgically treated patients, a wound infection required intravenous antibiotic treatment. In the non-operatively treated cohort, one patient developed a deep venous thrombosis in the fractured leg.

According to results of this study, in adult patients with an isolated distal fibula and medial clear space ≤6 mm, without proven instability these fractures can safely be treated non-operatively, while avoiding risks and costs of surgery and preserving good long-term outcome in terms of pain and function.