Medial Malleolar Fractures
Management
Carter et al JAMA Netw Open 2024
- RCT of operative versus nonoperative medial malleolus
- 144 patients with ORIF fibular +/- posterior malleolus
- medial malleolus in satisfactory position
- nonunion: fixation 0%, non operative 20% (1/13 required surgery)
Displaced
- ORIF
- 20% risk of non union
Undisplaced
- can usually manage in cast
- still small risk of non union
Approaches
AO surgery reference posteromedial approach ankle
Fixation options
| Large fracture | Small fracture | Vertical fracture |
|---|---|---|
| 2 partially threaded screws | Tension band wire | Buttress plate |
 |
 |
 |
Non-union
