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To fix or not to fix: a novel approach to the safe management of unstable open medial malleolar fractures
  1. Tom H Carter1,
  2. Calum HC Arthur2,
  3. Andrew D Duckworth2 and
  4. Timothy O White2
  1. 1 Division of Health Sciences, University of Edinburgh, Edinburgh, UK
  2. 2 Department of Edinburgh Orthopaedic Trauma, Royal Infirmary of Edinburgh, Edinburgh, UK
  1. Correspondence to Tom H Carter, carter.tom{at}


Displaced medial malleolar fractures, either in isolation or as part of an unstable ankle fracture dislocation, are conventionally treated with internal fixation. We outline the case of a 76-year-old man with diabetes presenting with a grossly deformed open ankle fracture and extruded tibia through a large medial wound. Following irrigation, wound debridement and minimally invasive fibular fixation, the medial fracture reduced anatomically. Contrary to traditional teaching, the medial malleolus was left without fixation. The patient mobilised partially weight-bearing, progressing to both clinical and radiographic union by 3 months. Nine months following an injury, he walks unaided, can squat and drive and has no medial pain or instability with an Olerud–Molander Ankle Score of 80/100, indicating a good outcome. This is the first reported case of such unique management in the literature and highlights the potential to treat open medial malleolar fractures safely without fixation, particularly when concerned about the soft tissue envelope.

  • orthopaedics
  • orthopaedic and trauma surgery
  • infections
  • diabetes
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  • Contributors All authors made a significant contribution to this manuscript. THC and CHCA: treating the patient, conception and design; THC, ADD and TOW: literature review; THC: revising the manuscript; all authors: drafting and approving the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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