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J Orthop Trauma. 2013 Nov;27(11):633-7. doi: 10.1097/BOT.0b013e31828e1bb7.

Nonoperative treatment of the medial malleolus in bimalleolar and trimalleolar ankle fractures: a randomized controlled trial.

Author information

1
Department of Orthopedic Surgery, Oslo University Hospital, Aker, Norway.

Abstract

OBJECTIVES:

To compare internal fixation with no fixation of the medial malleolus after open reduction and internal fixation of the lateral malleolus and if needed, the posterior malleolus.

DESIGN:

Randomized prospective trial.

SETTING:

Level III trauma center in a metropolitan area.

PATIENTS:

One hundred patients with bimalleolar or trimalleolar Orthopaedic Trauma Association type 44 ankle fractures and displacement of the medial malleolus less than 2 mm after open reduction and internal fixation of the lateral component.

INTERVENTION:

Internal fixation or nonoperative treatment of the medial malleolus.

MAIN OUTCOME MEASUREMENTS:

American Orthopaedic Foot and Ankle Society ankle hind foot score (AOFAS), The Olerud Molander Ankle (OMA) score, and visual analogue pain scale (VAS).

RESULTS:

Median follow-up time was 39 months (range: 24-72). There were no significant differences between the 2 groups with respect to OMA (P = 0.91), AOFAS (P = 0.85), VAS (P = 0.85), or development of osteoarthritis (P = 0.22). Reoperation and complication rates were also comparable, but 4 patients treated nonoperatively developed nonunion of the medial malleolus. These patients reported no functional disabilities and presented OMA, AOFAS, and VAS scores better than average.

CONCLUSIONS:

Our data indicate that nonoperative treatment of minimally displaced fractures of the medial malleolus after operative fixation of the fibula yields satisfactory results. However, long-term follow-up is needed due to increased risk of nonunion and uncertainty regarding the development of posttraumatic arthritis.

LEVEL OF EVIDENCE:

Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

PMID:
23454858
DOI:
10.1097/BOT.0b013e31828e1bb7
[Indexed for MEDLINE]

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