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

摘要

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.