Nonoperative Treatment of the Medial Malleolus in Bimalleolar and Trimalleolar Ankle Fractures

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

doi:10.1097/bot.0b013e31828e1bb7

Cited by 43 publications

(47 citation statements)

References 23 publications

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“…However long-term follow-up is needed due to increased risk of nonunion and uncertainity regarding the development of posttraumatic arthritis. 22 Hong et al in 2014 evaluated the clinical and functional outcome of trimalleolar fractures and the ability of patients to return to sporting activities. In their retrospective study of 31 patients they found that 11 patients had residual pain, 13 patients had persistent ankle stiffness, 10 patients had swelling at 1 year follow up.…”

Section: Inferencementioning

confidence: 99%

Functional Outcome Following Operative Treatment of Ankle Fractures

D'Almeida¹,

Thomas²,

Devasia³

et al. 2015

jemds

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Section: Inferencementioning

confidence: 99%

Functional Outcome Following Operative Treatment of Ankle Fractures

D'Almeida¹,

Thomas²,

Devasia³

et al. 2015

jemds

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“…Contemporary nonoperative management is generally recommended for isolated fractures that are nondisplaced or minimally displaced (≤2 mm), for avulsion injuries, for staging surgery as a result of compromised soft tissues, and for cases where medical comorbidities or patient preferences exclude operative in-tervention. 41 However, the literature has not consistently shown the superiority of operative management over nonoperative management. However, for nonunion or malunion, the decreased contact area and increased contact pressures have been found to be significant.…”

Section: Indications For Nonoperative Managementmentioning

confidence: 99%

“…Operative management is favored, 37,[45][46][47][48][49][50] but some studies found no difference in clinical or radiographic outcomes. 41,51 Tornetta 6 retrospectively reviewed a series of 27 bimalleolar ankle fractures and found that the size of the medial malleolar fragment was the most significant predictor of deltoid competence. This study found that the deltoid ligament was incompetent and the ankle was unstable on external rotation stress radiographs after fixation of all medial malleolar fractures less than 1.7 cm wide on lateral radiograph.…”

Section: Bi-and Trimalleolar Ankle Fracturesmentioning

confidence: 99%

Medial Malleolar Fractures and Associated Deltoid Ligament Disruptions: Current Management Controversies

Kusnezov¹,

Eisenstein²,

Diab³

et al. 2017

Orthopedics

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Operative fixation of medial malleolar fractures, whether isolated or in the setting of bi- or trimalleolar fractures, remains controversial. Increasingly, anatomic reduction and internal fixation is used to treat medial malleolar fractures to avoid long-term sequelae of symptomatic nonunion and posttraumatic osteoarthritis. However, outcomes have not been significantly different between operative and nonoperative cohorts. Repair of associated deltoid ligament disruption is not common because of reportedly poor outcomes. This review provides an overview of the literature on medial malleolar fracture fixation and current treatment options. [Orthopedics. 2017; 40(2):e216-e222.].

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“…However, long-term follow-up is needed due to increased risk of non-union and uncertainty regarding the development of posttraumatic arthritis. 22 Hong et al in 2014 evaluated the clinical and functional outcome of trimalleolar fractures and the ability of patients to return to sporting activities.…”

Section: Slmentioning

confidence: 99%

Functional Outcome of Ankle Fractures Treated Surgically: A Prospective Study

P¹,

Patil²,

S³

2016

jebmh

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BACKGROUND & OBJECTIVES Ankle fractures are among the most common injuries treated by orthopaedic surgeons. However, very few investigators have examined the functional recovery following operative treatment of ankle fractures. Anatomic restoration with open reduction and internal fixation is the goal of management in ankle fractures. The purpose of this study is to analyse the functional outcome following operative treatment of ankle fractures using subjective as well as objective criteria. METHODS 90 patients with ankle fractures who fulfilled the inclusion criteria were included in the study. All patients underwent surgical fixation of the fractures. The follow-up assessment which consisted of subjective (Pain, Walking, Activity, Radiographs, Ankle and Subtalar Joint Function) and objective (Olerud and Molander Ankle Score) evaluations, were performed at 6 weeks, 3 months and 6 months postoperatively. RESULTS Out of 90 patients, the commonest injury pattern seen was supination-external rotation, followed by supination-adduction. The most common modality of fixation for the lateral malleolus was 1/3 rd tubular plate and for the medial malleolus was 4 mm cannulated cancellous screws with washer. Syndesmotic screws were not applied in any of the cases. At 6 weeks follow-up 40% (n=36) had complications of persistent swelling, residual pain. We found a statistically significant improvement in the subjective assessment of pain, walking, activity levels, ankle and subtalar joint function from 3 rd month to 6 th month postoperatively. However, subjective radiographic assessment failed to show any statistically significant improvement. The mean Olerud and Molander Ankle Score was statistically significant 47.5±19.7 at 3 rd month post-op and, 81.7±16.2 at 6 th month post-op. Age was a significant predictor of final outcome, with younger patients having a better functional outcome. CONCLUSIONS Operative treatment for ankle fractures results in good functional outcome postoperatively. Anatomical reduction of the fracture is associated with better functional outcome. Early treatment without delay, anatomic reduction and fracture fixation, stringent postoperative mobilisation and rehabilitation should help improve outcome in an operated ankle fracture.

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Nonoperative Treatment of the Medial Malleolus in Bimalleolar and Trimalleolar Ankle Fractures

Abstract: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Cited by 43 publications

References 23 publications

Functional Outcome Following Operative Treatment of Ankle Fractures

Functional Outcome Following Operative Treatment of Ankle Fractures

Medial Malleolar Fractures and Associated Deltoid Ligament Disruptions: Current Management Controversies

Functional Outcome of Ankle Fractures Treated Surgically: A Prospective Study

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