Comparison of open reduction and internal fixation versus closed reduction and percutaneous fixation of medial malleolus fractures: a comparative study

Background
Medial malleolus fractures (MM) are the most common intra-articular fractures of a weight-bearing joint. Surgical treatment is frequent and is reported to improve patient functional outcome, quality of life and also avoid complications. This treatment consists of open reduction and internal fixation (ORIF) or closed reduction and percutaneous fixation (CRPF).
Aim
To compare ORIF versus CRPF of MM fractures for the assessment of union, functional outcome, and complications.
Patients and methods
A prospective randomized controlled clinical research has been performed at Ain Shams University Hospitals and Egyptian Railway Medical Center recruiting 50 patients with MM fracture mainly transverse types (25 cases undergoing ORIF, and 25 cases undergoing CRPF) starting from September 2023 to March 2024. We excluded skeletally immature patients, Charcot disease, comminuted fracture, correlated neurovascular injury and crush injury of foot and ankle, and avulsion of tip of MM (Type A).
Results
Regarding operative time, CRPF was statistically significant with mean±SD (35 ± 3.82) minutes when compared with ORIF (64 ± 8.16) min. The American Orthopedic Foot and Ankle Society scoring (AOFAS) scoring, which is an indicator of functional outcome, weight-bearing (weeks), and range of motion were statistically significant in CRPF rather than ORIF. Regarding postoperative complications, A statistically significant variance was observed among ORIF and CRPF with a P=0.017.
Conclusion
CRPF appeared to be superior concerning AOFAS as an indicator of functional outcome, weight-bearing, range of motion, and duration of operation. Insignificant variances among CRPF and ORIF in general complications involving infection of the wound, osteoarthritis, osteomyelitis and failure of fixation, Sudeck’s atrophy, and nonunion.