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Journal of Orthopaedic Trauma:
doi: 10.1097/BOT.0b013e31828e1bb7
Original Article

Nonoperative Treatment of the Medial Malleolus in Bimalleolar and Trimalleolar Ankle Fractures: A Randomized Controlled Trial

Hoelsbrekken, Sigurd Erik MD, PhD; Kaul-Jensen, Kjersti MD; Mørch, Thale MD; Vika, Håvard MD; Clementsen, Torkil MD; Paulsrud, Øyvind MD; Petursson, Gunnar MD; Stiris, Morten MD; Strømsøe, Knut MD, PhD

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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.

© 2013 by Lippincott Williams & Wilkins

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