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Operative versus nonoperative treatment of unstable lateral malleolar fractures: a randomized multicenter trial
David W Sanders1, Christina Tieszer, Bradley Corbett
1London Health Sciences Centre, Victoria Hospital, London, Canada. david.sanders@lhsc.on.ca
Objectives:
To compare clinical and functional outcomes after operative and nonoperative treatment of undisplaced, unstable, isolated fibula fractures.
Design:
Randomized multicenter clinical trial.
Setting:
Six level 1 trauma centers.
Patients/Participants:
Eighty-one patients with undisplaced, unstable, isolated fibula fractures as confirmed by an external rotation stress examination demonstrating an increase in medial clear space to 5 mm or greater were followed for 12 months after treatment.
Intervention:
Forty-one patients were treated operatively by open reduction and internal fixation of the fibula. Forty patients underwent nonoperative treatment, which included the use of a short leg cast or brace and protected weight bearing for 6 weeks.
Main Outcome Measurements:
Functional outcomes determined using the Olerud-Molander Ankle Score and the Short Form 36. Radiographic outcomes included measurement of union and displacement at each visit.
Results:
There were no statistically significant differences in functional outcome scores or pace of recovery between the operative and nonoperative groups at any time interval (β = -0.28, 3.49; P = 0.936). Complications in the nonoperative group included 8 patients with a medial clear space ≥5 mm and 8 patients with delayed union or nonunion. In the operative group, 5 patients had a surgical site infection and 5 patients required hardware removal.
Conclusions:
Patients managed operatively had equivalent functional outcomes compared with nonoperative treatment; however, the risk of displacement and problems with union was substantially lower in patients managed with surgery.
