🦶Operative vs Nonoperative Management of Unstable Medial Malleolus Fractures Published in @JAMANetworkOpen 🔍Background Are internal fixations necessary for well-reduced medial malleolus fractures after fibular stabilization, or can non-fixation yield comparable outcomes? This question addresses the balance between avoiding soft tissue and implant-related complications and ensuring optimal fracture healing. 🏗️Methods Design: Superiority, pragmatic, parallel, prospective randomized clinical trial. Setting: Academic major trauma center in the UK. Participants: 154 adult participants (≥16 years) with closed, unstable bimalleolar or trimalleolar ankle fractures requiring surgery. Exclusion criteria included no medial-sided fracture, open fractures, neurovascular injury, and inability to comply with follow-up. Interventions: Fixation (n=78) vs nonfixation (n=76) of the medial malleolus after fibular stabilization. Randomization: Conducted intraoperatively, with allocation to groups via individually numbered opaque envelopes. Primary Outcomes: Olerud-Molander Ankle Score (OMAS) at 1 year (0-100 scale). Secondary Outcomes: Manchester-Oxford Foot Questionnaire (MOXFQ), EuroQol-5D-3L (EQ-5D), visual analog scales for pain, health, satisfaction, return time to work. 📊Results Primary Outcome: Median OMAS scores were not significantly different between groups, up to 1 year follow-up (p<0.05 for all). Secondary Outcome: No differences in pain, MOXFQ, quality of life (EQ-5D), health, satisfaction, or time to return to work or sport were observed between the two groups (p>0.05 for all). Complications & Radiographic Outcomes: The rate of non-union in the non-fixation group was 20% compared to 0% in the fixation group. No difference in the odds of complications (p=0.73). ✅Interpretation Fixation of well-reduced medial malleolus fractures did not show superiority in functional outcomes compared to non-fixation after fibular stabilization. However, a higher rate of radiographic nonunion was observed in the non-fixation group. These findings support selective non-fixation, but caution is advised for fractures that remain displaced post-stabilization. #ResearchTopic #ClinicalTrial #Orthopedics 🦴💉