The Medial Malleolus: Which Fractures Need to be Fixed?

Description

This presentation by Tom Carter addresses the treatment methods for fractures of the medial malleolus, focusing on the decision between fixation and non-fixation. Carter discusses the implications of each approach, including risks such as infection and metalwork issues versus concerns of nonunion and instability. He highlights that certain fractures, particularly vertically unstable SAD type injuries, typically require fixation, while others may not. A key part of the presentation covers the results from a recent randomized controlled trial (RCT) conducted in Edinburgh, scrutinizing whether internal fixation of well-reduced fractures is superior to non-fixation after stabilizing the fibula. Key findings concluded that neither approach significantly outperformed the other based on the Oxford Malleolar Assessment Score (OMAS) at one-year follow-up. The speaker points out that though fixation often yields better functional outcomes, it comes at the cost of more complications, including a notable rate of radiographic nonunion in the non-fixed group. The findings suggest conservation in surgical intervention should be considered, particularly for patients with compromised medial soft tissues. Carter concludes with the recommendation to reserve non-fixation for high-risk patients or those with poor tissue quality.

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