- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05412693
Functional Orthosis Versus Cast Immobilization for Partially Unstable Weber B Ankle Fractures
January 27, 2023 updated by: Marius Molund, Ostfold Hospital Trust
Six Weeks Functional Orthosis Versus Cast Immobilization for Partially Unstable Weber B/SER4a Ankle Fractures - a Multicenter Randomized Non-inferiority Trial
Stability dictates treatment choice for trans-syndesmotic fibula fractures.
Optimal treatment for partially unstable fractures remains a topic of debate.
The purpose of this study is to evaluate possible outcome non-inferior of functional orthosis treatment versus cast immobilization for these fractures.
Study Overview
Status
Recruiting
Conditions
Intervention / Treatment
Detailed Description
Evidence suggests that Weber B ankle fractures should be treated nonoperatively if the ankle mortise is stable.
Stability is maintained if the deltoid ligament is intact, also known as a Weber B/SER2 injury.
Functional orthosis treatment is advised for these injuries.
Recently, authors have demonstrated that the fractured ankle can be functionally stable even with a partial deltoid ligament injury.
Our interpretation of a partial deltoid ligament injury is when weightbearing radiographs indicate stability (no increase in medial clear space), while concomitant gravity stress radiographs indicate instability (due to increase in medial clear space).
It is suggested that this is referred to as a Weber B/SER4a injury.
Although now considered for nonoperative treatment, partially unstable/SER4a injuries were traditionally treated operatively.
Today, the superiority of one method of nonoperative treatment over another for partially unstable/SER4a injuries remains unclear.
Some authors advocate cast immobilization while others have shown good outcomes after inconsistently using different orthoses and cast devices.
The argument for cast immobilization appears to be a fear of posttraumatic osteoarthritis because of potential recurrent instability.
As a result, cast immobilization of partially unstable/SER4a fractures is implemented in reference European guidelines, and thus must be considered the reference treatment.
To our knowledge, no study has documented increased prevalence of osteoarthritis associated with functional treatment of partially unstable/SER4a fractures.
The use of cast immobilization remains a precautionary principle, but the choice is not so clear cut because cast immobilization comes with an increased risk of joint stiffness and thromboembolic complications.
Long-term radiographic and patient-reported outcome data evaluating possible non-inferiority of functional orthosis treatment compared to cast immobilization will assist in guiding future treatment strategies of these common fractures.
Study Type
Interventional
Enrollment (Anticipated)
110
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Contact
- Name: Martin Gregersen
- Phone Number: 48171718
- Email: martinggregersen@gmail.com
Study Locations
-
-
-
Gjøvik, Norway
- Recruiting
- Sykehuset Innlandet, Gjøvik
-
Contact:
- Nicolaj Quist Gill
- Email: Nicolaj.Emil.Quist.Gill@sykehuset-innlandet.no
-
Contact:
- Håvard Furunes
- Email: havardfurunes@gmail.com
-
Ålesund, Norway
- Recruiting
- Alesund Hospital
-
Contact:
- Ragnhild Justad-Berg
- Email: ragnhild.therese.justad-berg@helse-mr.no
-
Contact:
- Lars Kjetil Aas
- Email: Lars.Kjetil.Aas@helse-mr.no
-
-
Østfold
-
Sarpsborg, Østfold, Norway, 1714
- Recruiting
- Østfold Hospital Trust
-
Contact:
- Martin Greger Gregersen, PhD candidate
- Phone Number: +4748171718
- Email: martingjohansen@gmail.com
-
Contact:
- Marius Molund, PhD
- Phone Number: +4790093988
- Email: marius.molund@so-hf.no
-
-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
18 years to 80 years (Adult, Older Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- Patients:
- With isolated Weber type B fractures that are deemed stable on weightbearing radiographs (MCS injured ankle - MCS uninjured ankle < 1 mm).
- With concomitant gravity stress test evaluated as unstable (MCS injured ankle - MCS uninjured ankle < 1 mm)
- Presenting to one of the participating hospitals, and that are available for stability evaluation within 14 days after injury.
- 18-80 years of age
- With pre-injury walking ability without aids.
Exclusion Criteria:
- Patients:
- with fracture of the medial malleolus, pre-hospital closed fracture reduction, open fracture, fracture resulting from high-energy trauma or multi-trauma or pathologic fracture.
- with fracture of the posterior malleolus involving 25% or more of the joint surface or with a step of the intraarticular surface. (non-displaced fractures smaller than 25% can be included)
- with neuropathies and generalized joint disease such as Rheumatoid Arthritis.
- that are assumed not compliant (drug use, cognitive- and/or psychiatric disorders).
- with previous history of ipsilateral ankle fracture.
- with previous history of ipsilateral major ankle-/foot surgery.
- who live outside one of the participating hospitals catchment areas (not available for follow-up).
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Functional orthosis
Use of a functional orthosis device (AirCast Air-Stirrup) for 6 weeks.
Weightbearing as tolerated will be allowed in both groups immediately after application of the cast or orthosis.
|
See arm descriptions
|
Active Comparator: Cast immobilization
Use of a below-the-knee cast circular cast (3M scotch cast) for 6 weeks.
|
See arm descriptions
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change from 6 weeks Manchester-Oxford Foot and Ankle Questionnaire score at 2 years
Time Frame: 6 weeks, 2 years
|
Scale 0-100, lower scores indicate less pain and symptoms.
|
6 weeks, 2 years
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change from 6 weeks Olerud Molander Ankle Score at 2 years
Time Frame: 6 weeks, 2 years
|
Scale 0-100, higher scores indicate less pain and symptoms.
|
6 weeks, 2 years
|
Numeric rating scale of of patient satisfaction with treatment protocol
Time Frame: 6 weeks
|
A 0-10 rating scale for perceived satisfaction with orthosis or cast
|
6 weeks
|
Change from baseline tibiotalar congruity at 2 years
Time Frame: Baseline, 2 years
|
Measurement of ankle medial clear space from weightbearing and gravity stress ankle radiographs
|
Baseline, 2 years
|
Registrations of complications/adverse events
Time Frame: 2 years
|
Registration of possible loss of congruence, delayed union, non-union, thromboembolic events
|
2 years
|
Change from 6 weeks ankle range of motion at 2 years
Time Frame: 6 weeks, 2 years
|
Measurement using a goniometer (ad modum Lindsjø)
|
6 weeks, 2 years
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
May 15, 2022
Primary Completion (Anticipated)
December 31, 2025
Study Completion (Anticipated)
December 31, 2025
Study Registration Dates
First Submitted
May 6, 2022
First Submitted That Met QC Criteria
June 7, 2022
First Posted (Actual)
June 9, 2022
Study Record Updates
Last Update Posted (Estimate)
January 30, 2023
Last Update Submitted That Met QC Criteria
January 27, 2023
Last Verified
January 1, 2023
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 22/00257-3
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
No
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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