Discover the latest insights from a groundbreaking study comparing surgical and nonsurgical treatments for unstable medial malleolus fractures, and learn which approach may lead to better patient outcomes.
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Operative vs Nonoperative Management of Unstable Medial Malleolus Fractures: A Randomized Clinical Trial.
Carter et al., JAMA Netw Open 2024
DOI: 10.1001/jamanetworkopen.2023.51308
Study Summary:
A randomized clinical trial investigated whether internal fixation of well-reduced medial malleolus fractures is superior to nonfixation after fibular stabilization. Conducted from 2017 to 2021, the study involved 154 adults with unstable bimalleolar or trimalleolar ankle fractures requiring surgery. Participants were randomly assigned to either fixation (n=78) or nonfixation (n=76) groups after satisfactory intraoperative reduction of the medial malleolus fracture.
Key Findings:
- The primary outcome measure was the Olerud-Molander Ankle Score (OMAS) at 1 year, with a median score of 80.0 in the fixation group and 72.5 in the nonfixation group, which was not statistically significant (P=0.17).
- Complication rates were similar between groups.
- Nonfixation resulted in a 20% radiographic nonunion rate, significantly higher than in the fixation group (0%; P<0.001), with most cases being asymptomatic.
- One patient in the nonfixation group required surgical reintervention due to nonunion.
Implications:
The study suggests that fixation of well-reduced medial malleolus fractures is not necessarily superior to nonfixation after fibular stabilization, based on the OMAS at 1 year. However, the higher nonunion rate in the nonfixation group raises concerns about the long-term implications. These findings support the idea of selectively not fixing anatomically reduced medial malleolar fractures after fibular stabilization, but further research is needed to understand the future consequences of nonunion.
Study Registration:
The trial was registered at ClinicalTrials.gov (Identifier: NCT03362229).