DOS 2017

DOS Kongressen 2017 ·

175

Displaced isolated lateral malleolar fractures –Out-

come at 3 months following non-operative treat-

ment: Early results from the PRO-Malleol study

Mads Terndrup, Ilija Ban, Morten Grove Thomsen , Søren Kring, Peter Toft Teng-

berg

Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre

; Department of Orthopaedic Surgery, Copenhagen University Hospital Hvi-

dovre ; Department of Orthopaedic Surgery, Copenhagen University Hospital

Hvidovre; Department of Orthopaedic Surgery, Copenhagen University Hospital

Hvidovre

Background:

Operative treatment of isolated lateral malleolar fractures is of-

ten considered if fracture displacement is >2mm, combined with apparent rota-

tion of the distal fibular fragment

Purpose / Aim of Study:

To examine functional outcome after 3 months and

need of secondary surgery in a prospective cohort

Materials and Methods:

Adult patients with isolated lateral malleolar frac-

tures, without talar shift or observed ankle displacement, were allowed full

weight bearing in a walker boot. Patients were reassessed with weight bearing

radiographs after 1 week. At follow up (6 and 12 weeks) questionnaires includ-

ing satisfaction, VAS and Olerud Molander ankle scores (OMAS) were complet-

ed. Follow up was set in a dedicated ankle fracture out-patient clinic as part of

the “PRO-Malleol algorithm” study

Findings / Results:

In 31 of 102 patients treated non-operatively, fractures

were displaced >2mm and with apparent rotation of the distal fragment. All

31 patients had AO 44B1/B2.1 type fractures. At 6 weeks all reported to be

satisfied, with median VAS score 1.4 and OMAS 43 (fair) [5 – 75]. However,

at 3 months 4 patients were not-satisfied, median VAS increased to 1.9 and

three patients had persisting pain, no signs of union and later required surgery.

Two patients reported decreased sensibility corresponding to the deep peroneal

nerve. Median OMAS was 63 (good) [30 – 100] at 3 months. No secondary

talar shift or thromboembolic events were observed

Conclusions:

28/31 patients (90.3%) with >2 mm displacement and appar-

ent rotation of the distal fibula were successfully managed non-operatively at

3 months follow up. If long term functional outcome is satisfactory, non-op-

erative treatment should be considered for displaced isolated lateral malleolar

fractures, despite a non-union rate of 9,7%, as primary surgical treatment for

these patients is also not without risk

No conflicts of interest reported

127.