title: Nonoperative treatment of the medial malleolus in bimalleolar and trimalleolar ankle fractures: a randomized controlled trial.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Randomized prospective trial.
  
  
  METHODS
  Level III trauma center in a metropolitan area.
  
  
  METHODS
  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.
  
  
  METHODS
  Internal fixation or nonoperative treatment of the medial malleolus.
  
  
  METHODS
  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.
  
  
  METHODS
  Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
authors: Department of Orthopedic Surgery, Oslo University Hospital, Aker, Norway.
authors: Sigurd Erik
authors: SE
authors: Hoelsbrekken
authors: Kjersti
authors: K
authors: Kaul-Jensen
authors: Thale
authors: T
authors: Mørch
authors: Håvard
authors: H
authors: Vika
authors: Torkil
authors: T
authors: Clementsen
authors: Øyvind
authors: Ø
authors: Paulsrud
authors: Gunnar
authors: G
authors: Petursson
authors: Morten
authors: M
authors: Stiris
authors: Knut
authors: K
authors: Strømsøe
mesh_terms: D000328:Adult; D000368:Aged; D064386:Ankle Fractures; D000843:Ankle Joint / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal; D050723:Fractures, Bone / Q000628:therapy; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010147:Pain Measurement; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012086:Reoperation