• Sigurd Erik Hoelsbrekken, Kjersti Kaul-Jensen, Thale Mørch, Håvard Vika, Torkil Clementsen, Øyvind Paulsrud, Gunnar Petursson, Morten Stiris, and Knut Strømsøe.
• Department of Orthopedic Surgery, Oslo University Hospital, Aker, Norway.
• J Orthop Trauma. 2013 Nov 1; 27 (11): 633-7.

ObjectivesTo 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.DesignRandomized prospective trial.SettingLevel III trauma center in a metropolitan area.PatientsOne 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.InterventionInternal fixation or nonoperative treatment of the medial malleolus.Main Outcome MeasurementsAmerican Orthopaedic Foot and Ankle Society ankle hind foot score (AOFAS), The Olerud Molander Ankle (OMA) score, and visual analogue pain scale (VAS).ResultsMedian 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.ConclusionsOur 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 EvidenceTherapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

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