From the Guidelines
The treatment for an undisplaced fracture of the medial malleolus typically involves simple immobilization, as surgery is not usually required for non-displaced or minimally displaced fractures. This approach is based on the principle that small, non-articular, or minimally displaced fracture fragments can heal adequately with immobilization alone 1. The goal of treatment is to promote healing, reduce pain and swelling, and restore function to the ankle.
Key considerations in the management of an undisplaced medial malleolus fracture include:
- Immobilization: Using a short leg cast or a removable walking boot for 6-8 weeks to allow the fracture to heal
- Weight bearing status: Maintaining non-weight bearing or partial weight bearing status for the first 4-6 weeks, gradually progressing to full weight bearing as healing occurs and pain subsides
- Pain management: Using acetaminophen or NSAIDs like ibuprofen for the first 1-2 weeks to control pain and inflammation
- Follow-up care: Regular orthopedic evaluation and X-rays at 2,4, and 6 weeks to ensure proper healing and alignment
- Rehabilitation: Starting physical therapy after cast removal to restore range of motion, strength, and proprioception
It is essential to note that surgery may be considered in certain cases, such as highly active patients or athletes who require a faster return to activities. However, for most patients with undisplaced medial malleolus fractures, a conservative approach with immobilization and non-surgical management is the recommended treatment 1.
From the Research
Treatment Options for Undisplaced Fracture of the Medial Malleolus
- Conservative treatment is a viable option for undisplaced fractures of the medial malleolus, as evidenced by studies 2, 3, 4
- Immobilization in a cast can lead to high rates of union and good functional results, with minimal complications 2
- The decision to treat conservatively or surgically may depend on the degree of fracture displacement, with fractures displaced ≤2 mm potentially being safe for conservative treatment 4
- Surgical treatment, such as internal fixation, may be reserved for more complex or displaced fractures, or those with associated injuries 5, 6
Key Considerations
- Fracture displacement is a crucial factor in determining the treatment approach, with ≤2 mm displacement potentially being suitable for conservative treatment 3, 4
- The presence of associated injuries, such as open fractures or skin compromise, may necessitate surgical intervention 5
- Patient characteristics and demands may also influence the choice of treatment, particularly for fractures displaced >2 mm 4
Outcomes and Complications
- Conservative treatment has been shown to result in high rates of union and good functional outcomes, with minimal complications 2, 3
- Surgical treatment, such as headless compression screw fixation, can provide effective compression and good clinical outcomes, with low rates of hardware removal and non-union 6