All patients were placed in a splint at the time of surgery for 2 weeks until the first postoperative clinic visit. Postoperation, patients returned to the clinic at 2 weeks, 6 weeks, 3 months, and 6 months. Based on the Orthopaedic Trauma Association fracture classification system (44), the patterns included were groups 44-A2, A3, B2, B3, C1, C2, C3. Injury patterns were assessed on initial injury radiographs those included were isolated MM fractures, bimalleolar fractures, and trimalleolar fractures. Group inclusion was determined through reading surgical reports, with the CRPF group including patients with a medial wound or with wounds limited to stab incisions made for hardware insertion only, and the ORIF group including longer incisions that involved direct fracture visualization with either subsequent screw, plate and screw, or tension band fixation. After applying exclusion criteria, there were 165 patients included in the study group, consisting of 31 in the CRPF group and 134 in the ORIF group. Exclusion factors were open fractures, pilon fractures, ipsilateral tibial shaft fractures, pathologic fractures, fractures in children (ie, <18 years of age), and patients without preoperative clinical and/or radiographic data. To meet inclusion criteria, patients must have sustained a closed MM fracture that was managed definitively with internal fixation and must have been clinically followed until union occurred or the patient was given the diagnoses of nonunion. Clinical records and radiographs were reviewed to identify those eligible for inclusion. We hypothesized that the two groups would be similar in regard to patient factors, injury variables, and outcomes.Īfter obtaining institutional review board approval, 490 consecutive patients who underwent fixation for an MM fracture from 2011 to 2015 were retrospectively identified using Current Procedural Terminology codes for open treatment of ankle fractures (MM, 27766 bimalleolar, 27814). The purpose of this study was to compare two groups of patients treated with surgical fixation of MM fractures: one group treated with closed reduction and percutaneous fixation (CRPF) and another group treated with traditional open reduction and internal fixation (ORIF). We are unaware of any comparison of the two approaches to MM reduction. 14, 15, 16, 17, 18 However, without direct fracture visualization and fracture site débridement, it is possible that acceptable reduction could be hindered, leading to higher rates of nonunion and malunion.
12, 13 In comparison to an open technique, a percutaneous approach offers the potential advantage of decreased surgical morbidity, decreased postoperative pain, and decreased risk of wound complications. 7 Percutaneous and minimally invasive approaches to MM fracture fixation have been previously described. These fixation techniques typically involve a traditional open approach to fracture reduction and fixation.Īlthough a variety exists regarding fixation options, a percutaneous approach to MM fixation has not been included in recommendations put forth by the AO group. 7, 8, 9, 10, 11 Important considerations when deciding on a particular fixation technique include fracture geometry and the extent of comminution. Several fixation techniques for MM fractures have been described, including unicortical partially threaded compression screws, bicortical fully threaded screws, buttress or neutralization plating, and tension band fixation. There is some evidence to support the use of conservative treatment for isolated MM fractures 4 however, surgical treatment of isolated MM fractures, particularly when displacement is present, is well supported in the literature. When part of a bi- or tri-malleolar ankle injury, MM fractures are typically treated with surgical fixation. 1, 2 Medial malleolus (MM) fractures are involved in approximately 50% of all ankle fractures 3 and may occur in isolation or as part of a bi- or tri-malleolar ankle injury. Malleolar fractures occur commonly, with reports of annual incidence between 101 and 187 per 100,000.
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