Operative versus nonoperative treatment of unstable lateral malleolar fractures: a randomized multicenter trial

J Orthop Trauma. 2012 Mar;26(3):129-34. doi: 10.1097/BOT.0b013e3182460837.


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.

Publication types

  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Ankle Injuries / diagnostic imaging
  • Ankle Injuries / physiopathology
  • Ankle Injuries / surgery*
  • Ankle Joint / diagnostic imaging
  • Ankle Joint / physiopathology
  • Ankle Joint / surgery*
  • Bone Malalignment
  • Braces
  • Casts, Surgical
  • Female
  • Fibula / diagnostic imaging
  • Fibula / injuries*
  • Fracture Fixation, Internal / methods*
  • Fracture Healing
  • Fractures, Bone / diagnostic imaging
  • Fractures, Bone / physiopathology
  • Fractures, Bone / therapy*
  • Humans
  • Joint Dislocations
  • Joint Instability
  • Male
  • Postoperative Complications
  • Radiography
  • Range of Motion, Articular
  • Recovery of Function
  • Treatment Outcome