Retrospective comparison of minimal and extensive fixation strategies in operatively treated ankle fractures

Ankle fractures are among the most common orthopedic injuries, with open reduction and internal fixation (ORIF) being the standard treatment for displaced fractures. This retrospective study compared operative time, radiographic and complication outcomes between two fixation strategy categories, minimal fixation and extensive fixation, in operatively treated ankle fractures.

A retrospective review included 95 patients treated surgically for displaced Danis Weber B or C ankle fractures between January 2017 and November 2019. Patients were grouped by fixation strategy at index surgery, minimal versus extensive hardware, selected by the treating surgeon. Demographic, intraoperative, and hospitalization data were collected. Presentation and follow-up radiographs were assessed for fracture classification, maintenance of reduction, fracture healing, and hardware-related complications. Revision surgeries were recorded, and outcomes were compared between groups.

Twenty-seven patients underwent minimal fixation, most commonly with a posterior antiglide plate. Sixty-eight patients underwent extensive fixation, typically a one-third tubular plate with extensive screw placement. Demographics were similar, and most fractures were Weber B, supination external rotation. Operative time was shorter with minimal fixation, with a mean of 58.7 minutes versus 86.6 minutes (p < 0.001). Postoperative complication and revision rates were not statistically different. Loss of reduction was more frequent with minimal fixation, at 14.8% versus 2.9%, approaching significance (p = 0.053).

Minimal fixation for unstable ankle fractures showed comparable early radiographic outcomes and complication rates to more extensive lateral or anatomic plate fixation, with significantly shorter operative time. Findings should be interpreted cautiously given surgeon selected fixation and group heterogeneity.