Percutaneous versus open cannulated screws fixation for displaced isolated medial malleolar fractures in adults: a randomized controlled clinical trial

TL;DR

This study compares two surgical methods for treating adult medial malleolar fractures and finds both are similarly effective.

Contribution

The study provides new evidence that percutaneous fixation is as effective as open surgery for isolated medial malleolar fractures.

Findings

CRPF and ORIF showed comparable functional outcomes in activities of daily living and sports.

CRPF had a shorter time to radiographic union compared to ORIF.

Both methods resulted in low pain levels and high patient satisfaction scores.

Abstract

Isolated medial malleolar (MM) fractures are infrequent injuries. Studies focused on their treatment are scarce. The aim of this study was to compare functional and radiographic outcomes of two surgical techniques for treatment of displaced isolated MM fractures in adults: closed reduction and percutaneous fixation (CRPF), and open reduction and internal fixation (ORIF) by using same implant; two partially-threaded cannulated cancellous screws.

A prospective randomized controlled clinical trial (RCT) was conducted on 50 patients with isolated displaced MM fractures, treated with CRPF (group A) or ORIF (group B), at orthopaedics department of university hospital, from April 2021 to April 2023. Fractures were classified by Herscovici classification. The primary outcomes were incidence of complications and time to union based on radiographic assessment by plain radiographs of ankle. The secondary outcomes were functional assessment by Foot and Ankle Ability Measure (FAAM) for activities of daily living (ADLs) and sports, American Orthopaedic Foot and Ankle Society (AOFAS) score, and VAS.

No significant differences were noticed among two groups regarding age, sex, side affected, mechanism of injury, smoking, Herscovici classification, or follow-up duration. Mean final FAAM-ADLs was 97.6 ± 2 in group A, and 95 ± 3.4 in group B, (P = 0.155). Mean final FAAM-sports was 87 ± 11.4 in group A, and 73.4 ± 15.6 in group B, (P = 0.312). Mean final AOFAS score was 95.9 ± 8.4 in group A, and 94.6 ± 9.5 in group B, (P = 0.237). Mean final VAS for pain was 0.9 ± 0.5in group A, and 1.5 ± 0.9 in group B, (P = 0.453). Mean time of solid radiographic union was 9.5 ± 2 weeks in group A, and 10.4 ± 3 weeks in group B, (P = 0.026).

CRPF of displaced isolated MM fractures is an efficient method with comparable radiographic and functional outcomes to ORIF. Based on these results, percutaneous fixation could be a good alternative for managing displaced isolated MM fractures.

Level II therapeutic: Prospective randomized controlled clinical trial.

The trial was registered at www.clinicaltrials.gov (Trial Registration Number: NCT06883435).

The online version contains supplementary material available at 10.1007/s00402-025-06000-w.

Figures