A Functional Outcome on Different Surgical Treatment Modalities of Bimalleolar Fractures in Adults

This study aimed to evaluate and compare the functional outcomes of adult patients with displaced closed bimalleolar ankle fractures treated with open reduction and internal fixation (ORIF) using different fixation modalities. The choice of implant and fixation technique was determined by fracture morphology, bone quality, and intraoperative stability assessment rather than age-specific criteria. The study further assessed whether functional outcomes differed across these modality-based treatment approaches.

A prospective observational study was conducted between September 2023 and June 2025. It included 30 adult patients (aged 18-70 years) with displaced closed bimalleolar ankle fractures treated surgically using various fixation techniques, including cancellous compression (CC) screws, plates and screws, and tension band wiring (TBW). Postoperative outcomes assessed were fracture union time, range of motion (ROM), and functional status using the Olerud and Molander Ankle Score (OMAS). Statistical analyses were performed to evaluate associations between fixation methods and functional outcomes.

Most patients were aged 21-40 years (n=16, 54%), and 18 (60%) were male. Road traffic accidents were the most common mechanism of injury (n=16, 53%), followed by falls from height (n=9, 30%) and twisting injuries (n=5, 17%) (χ²=6.18, df=2, p=0.045). Supination-external rotation and pronation-external rotation fractures were the most frequent patterns (n=9, 30% each). Fracture union was achieved in all patients. Functional outcomes were favorable: 26 patients (87%) demonstrated "good" objective outcomes, and 14 (47%) reported "excellent" subjective outcomes. No significant differences were observed in age distribution or functional outcomes among the fixation methods (p=0.34 and p=0.457, respectively). However, fracture type showed a significant association with age (F=12.13, p=0.0001).

Anatomical reduction with stable fixation using appropriate implants results in optimal restoration of ankle function following displaced bimalleolar fractures. Functional outcomes were comparable across fixation techniques when principles such as early surgical intervention, syndesmotic stability, and accurate joint alignment were maintained. Early fixation and precise anatomical reconstruction remain critical determinants of successful recovery.