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Research The Representativeness of An Isolated Medial Malleolar Fracture


 Background: An isolated medial malleolar fracture (IMMF) is relatively uncommon.Not only is the treatment principle undetermined well, but also is the patho-mechanism debatable. The goal of this retrospective study intended to clarify the patho-mechanism of an IMMF and develop an optimal treatment principle to upgrade a success rate.Methods: For the 10-year period, 59 consecutive adult patients (average, 38 years; range, 18-77 years) with an IMMF were treated. The causes included 42.4% of motorcycle accidents, 20.3% of working injuries, 10.2% of car accidents, 10.2% of slide injuries, and 16.9% of others. The 59 injuries were classified to 59.3% of stage 1 pronation-external rotation (PE), 20.3% of stage 2 PE, 10.2% of stage 2 pronation-abduction (PA), and 10.2% of stage 2 supination-adduction (SA) injuries. Unstable fractures which comprised stage 2 PA and stage 2 SA injuries were treated with internal fixation. Stable fractures which comprised stage 1 PE and stage 2 PE injuries were treated with either internal fixation or conservative techniques.Results: Fifty patients (84.7%, 50 / 59) were followed for at least one year (average, 1.3 years; range, 1-3.1 years). Forty-nine fractures healed with a union rate of 98%. Satisfactory ankle function was achieved in 84% of patients (42 / 50). Four out of eight patients with an unsatisfactory ankle function sustained syndesmotic diastasis. One fracture which was treated with internal fixation sustained screw breakage with nonunion. This patient also had unsatisfactory ankle function.Conclusion: Not all IMMFs can be treated conservatively. Practically, an IMMF should be classified into a stable or unstable type based on radiographs and clinical stress tests. A stable type may include 80% of IMMFs which may be treated with either surgical or conservative techniques. An unstable type may include 20% of IMMFs which had better be treated with internal fixation.