Combined Randomised and Observational Study of Surgery for Type B Ankle Fracture Treatment (CROSSBAT) Minimum 5 Year Follow-Up

Category: Trauma; Ankle Introduction/Purpose: Isolated Type B ankle fractures are common. The study (CROSSBAT: Combined Randomised and Observational Study of Surgery for Type B Ankle Fracture Treatment) demonstrated that surgical management was not superior to non-surgical management for the treatment of 44-B1 ankle (fibula) fractures with minimal talar shift at one-year post-injury. The current study presents longer term results of that cohort with a minimum 5-year follow-up. It aims to determine whether surgical management confers improved outcomes for participants with isolated AO type 44-B1 distal fibula fractures when compared with non-surgical management at minimum 5 years post- injury. Methods: A multi-centre, randomised controlled trial with an observational cohort was conducted. Participants were recruited from 22 hospitals across Australia and New Zealand. Participants consenting to follow-up but not randomisation formed the observational cohort. SURGICAL GROUP: Fracture fixation using a plate and screws. Post-operatively, ankles were splinted and participants were non-weight-bearing for 2 weeks, then weight-bearing was allowed; NON-SURGICAL GROUP: Ankles were splinted and participants were allowed to weight-bear. OUTCOMES: All participants were followed with a minimum 5-year follow-up. Primary outcomes were the American Academy of Orthopaedic Surgeons Foot and Ankle Outcomes Questionnaire (FAOQ) and the physical component score (PCS) of SF-12v2 general-health survey at 12 months. The randomised and observational cohorts were analysed separately. Results: Between August 2010 to October 2013 160 people were randomised (80 surgical and 80 non- surgical). 276 formed the observational cohort (19 surgical and 257 non-surgical). At minimum 5 year follow-up, 75 (47%) and 103 (37%) in the randomised and observational cohort respectively were contactable. Surgery was not superior for ankle function score or SF-12v2 compared with non-surgical group in the randomised or observational cohorts. Conclusion: Surgical management was not superior to non-surgical management in patients who sustained a distal fibula fracture with minimal talar shift.