Results of fixation of medial malleolus fractures with closed versus open reduction
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20252625Keywords:
Medial malleolus, Fracture, Closed reduction, Open reduction, Outcomes, Complications, FixationAbstract
Background: Medial malleolus fractures are common ankle injuries with varied treatment approaches, most notably closed and open reduction techniques. Each method presents distinct outcomes and complication profiles. The study aimed to investigate and compare the clinical and radiological outcomes of both techniques in a local context and in comparison, with international literature.
Methods: A prospective-retrospective study was conducted at Aleppo University Hospital, orthopedic surgery Branch, between January 2020 and January 2025. A total of 67 patients with medial malleolar fractures were included. Patients underwent closed or open reduction based on clinical judgment. Data were collected via clinical examination, medical history, radiological, and laboratory investigations. Outcomes and complications were statistically analyzed.
Results: The non-union rate was higher in the open reduction group (7.7%) than in the closed group (2.4%), but this was not statistically significant. However, the mean union time was significantly longer in the closed reduction group (14.6 weeks vs. 11.5 weeks, p=0.041). Complications such as infection, nerve injury, malunion, and joint stiffness were more frequent in the open reduction group. Secondary displacement and Sudeck’s atrophy were more frequent in the closed group, although none of these differences were statistically significant.
Conclusions: While both open and closed reduction techniques are effective in managing medial malleolus fractures, open reduction is associated with a higher rate of complications despite shorter union time. Closed reduction may be preferable in selected patients due to its favorable complication profile. These findings align with international data, although variations exist depending on study settings and sample characteristics.
Metrics
References
Solomon L, Warwick DJ, Nayagam S. Injuries of Ankle and Foot, Apley, S System of Orthopaedics and Fractures 8th Edition. Gustilo Classification of Open Fractures. 2002;733-58.
Carrj B, Hansen ST, Benirschke SK. Surgical Treatment of Foot and Ankle Trauma: Use of Indirect Reduction Techniques. Foot Ankle. 1989;9(4):176-8. DOI: https://doi.org/10.1177/107110078900900405
Abd El Ghany MA, Mashhour MA, Al-Ashhab ME, Farag HE. Comparative study between percutaneus and open reduction with internal fixation of medial malleolar fracture by lag screw in adults. Benha J Applied Sci. 2022;7(3):49-60. DOI: https://doi.org/10.21608/bjas.2022.244841
Matson AP, Barchick SR, Adams SB. Comparison of Open Reduction and Internal Fixation versus Closed Reduction and Percutaneous Fixation for Medial Malleolus Fractures. J Am Academy Orthop Surgeons. 2017;1(8):e048. DOI: https://doi.org/10.5435/JAAOSGlobal-D-17-00048
Ethiraj P, Venkataraman S, Shanthappa AH, Agrawal S. Medial Malleolar Fracture Management-A Comparative Study of Radiological Outcome between Open Reduction Internal Fixation and Closed Reduction Percutaneous Fixation. Int J Recent Surg Med Sci. 2022;9(1):S37-42 DOI: https://doi.org/10.1055/s-0042-1751083
Smith N, et al. Comparison of radiographic healing in open versus percutaneous fixation of medial malleolus fractures. J Foot Ankle Surg. 2019;58(2):212-7.
Matson AP, et al. Comparison of outcomes for closed reduction percutaneous fixation versus open reduction internal fixation of medial malleolar fractures. Foot Ankle Int. 2017;38(12):1310-6. DOI: https://doi.org/10.1177/2473011417S000286
Zhou Y, et al. Outcomes of posterior malleolus fixation: a systematic review and meta-analysis. Orthop Rev (Pavia). 2023;15(1):28-35.
Jang JH, Lee YK, Kim KC, et al. Radiographic union and outcomes after open versus percutaneous fixation of medial malleolar fractures. J Foot Ankle Surg. 2017;56(6):1179-83.
Matson AP, Hamid KS, Adams SB Jr. A comparison of open reduction internal fixation versus percutaneous fixation of medial malleolus fractures. J Orthop Trauma. 2018;32(10):e408-12.
Pieske O, Witt M, Hensel K, et al. Comparison of tension band wiring and fully threaded headless screw fixation in medial malleolus fractures. Foot Ankle Int. 2018;39(9):1044-51.
Zhang Y, Zhao Y, Li X, et al. Arthroscopically assisted minimally invasive fixation for medial malleolar fractures: Clinical outcomes and healing time. Orthop J Sports Med. 2023;11(3):23259671231157080.