Clinical Trial Details
— Status: Recruiting
Administrative data
NCT number |
NCT05131321 |
Other study ID # |
119571 |
Secondary ID |
|
Status |
Recruiting |
Phase |
|
First received |
|
Last updated |
|
Start date |
April 21, 2022 |
Est. completion date |
December 2026 |
Study information
Verified date |
October 2023 |
Source |
Lawson Health Research Institute |
Contact |
Emil Schemitsch, MD, FRCS(C) |
Phone |
519-663-3307 |
Email |
emil.schemitsch[@]lhsc.on.ca |
Is FDA regulated |
No |
Health authority |
|
Study type |
Observational
|
Clinical Trial Summary
This will be a multi-centre randomized controlled trial, with London Health Sciences Centre
(LHSC) as the lead site. Elderly patients with complex ankle fractures who meet the inclusion
criteria and provide consent will be randomized (through a web-based randomization system) to
one of the two treatment arms. One group (Group A) will receive primary ankle fusion, and the
second group (Group B) will receive primary ankle open reduction and internal fixation
(ORIF). Patient important outcomes will be compared at one year post injury
Description:
At the current time, there are few prospective studies comparing primary ankle arthrodesis
versus Open Reduction and internal fixation (ORIF) for the treatment of complex fractures
around the ankle in the frail elderly who have significant co-morbidities.
An effective alternative to ORIF that results in improved function, less post-operative pain
and a lower rate of complications is desirable, particularly in the setting of a severely
compromised soft tissue envelope, osteopenia or significant co-morbidities. Emerging clinical
evidence regarding primary ankle fusion is encouraging, suggesting several potential benefits
over ORIF in severely compromised cases including lower post-operative pain scores, improved
functional outcomes, lower complication rates, and high union rates. However, high level
evidence confirming these potential benefits is lacking. The results of the proposed
investigation would have significant implications for the management of orthopaedic trauma
patients with fragility fractures around the ankle and may in fact challenge ORIF as the gold
standard of treatment in some cases.
Aims & Hypotheses
Aims:
The Investigators aim to compare primary ankle arthrodesis to ORIF for the treatment of
complex fractures around the ankle in the frail elderly. The primary research question is:
1) Does primary ankle fusion for the treatment of severe fractures around the ankle in the
frail elderly result in improved outcomes and a lower rate of complications compared with
ORIF?
Hypotheses:
The Investigators hypothesize that:
1. Primary fusion will result in improved health related quality of life, functional
outcomes, pain and reduced complications compared to ORIF.
2. 2) Our null hypothesis is that primary fusion will not result in improved post-operative
health related quality of life, functional outcomes, pain, and complication rates
relative to ORIF for severe fractures around the ankle in the frail elderly.
Study Design
Design:
A multi-centre randomized clinical trial (RCT)
Setting: London Health Sciences Centre - Victoria Hospital, ON (coordinating centre); other
participating centres thus far include:
St. Michael's Hospital, ON, Winnipeg Regional Hospital, Winnipeg, MN, Royal Columbian
Hospital, New Westminster, BC.
Procedure: The local research team will screen admissions and clinic lists for eligible
patients who will be characterized and enrolled prospectively over a 2-year period and
followed according to the research ethics board (REB) approved protocol. Patients may also
consent to be contacted at 5 years to evaluate long-term changes in outcomes Full eligibility
will be determined during the primary appointment with an orthopaedic surgeon, following
appropriate radiographic scans, at which point an informed consent discussion will take
place. The local research team will measure and capture outcomes during regularly scheduled
clinic or hospital visits.