Study finds similar outcomes for operatively vs. nonoperatively managed ankle fractures
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TAMPA, Fla. — Presented results found no differences in outcomes for patients receiving operative vs. nonoperative management of unstable medial malleolar fractures at 1 year.
“Unstable bi and trimalleolar fractures are generally treated with medial malleolar fixation,” William M. Oliver, MBBS, MRCSE, said in his presentation at the Orthopaedic Trauma Association Annual Meeting. “However, due to concerns regarding softtissue and implant-related complications, several authors have proposed a role for nonoperative treatment of well-reduced medial fractures following fibular stabilization.”
Oliver and colleagues from the University of Edinburgh randomized 154 patients (mean age of 56.1 years) to undergo fixation (n = 78) or non-fixation (n = 76) of a well-reduced medial malleolar fracture after fibular stabilization, defined by a fluoroscopic displacement of less than or equal to 2 mm. Outcomes were collected at 1 year after intervention and included Olerud Molander Ankle Score (OMAS), Manchester-Oxford Foot Questionnaire (MOXFQ) and EuroQol-5 Dimensions-3 Levels (EQ-5D-3L).
At 1-year follow-up, 94% of patients (n = 144) had complete outcome measures. Researchers found no clinically significant differences in OMAS scores between the groups. Mean OMAS score was 74.3 for the fixation group and 69.9 for the non-fixation group. Oliver also noted no differences between the groups in MOXFQ scores or EQ-5D-3L.
“Internal fixation of the medial malleolus does not seem to be superior to non-fixation following fibular stabilization,” Oliver said. “On the medial side, the fixation obviously exposes patients to surgical risks and complications,” he added.
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Oliver WM, et al. Paper 88. Presented at: Orthopaedic Trauma Association Annual Meeting; Oct. 12-15, 2022; Tampa, Fla.
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