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Conservative versus operative treatment for displaced ankle fractures in patients over 55 years of age

A PROSPECTIVE, RANDOMISED STUDY

Trauma Orthopaedic Surgery, University Hospitals of Leicester NHS Trust, Groby Road, Leicester LE3 9QP, UK.

A. W. Hui, FRCS (Tr & Orth), Consultant Trauma and Orthopaedic Surgeon

Middlesborough General Hospital, Ayresome Green Lane, Middlesborough TS5 5AZ, UK.

Correspondence should be sent to Mr N. K. Makwana at Wrexham Maelor Hospital, Croesnewydd Road, Wrexham LL13 0DZ, UK.

Forty-seven patients over the age of 55 years with a displaced fracture of the ankle were entered into a prospective, randomised study in order to compare open reduction and internal fixation with closed treatment in a plaster cast; 36 were reviewed after a mean of 27 months. The outcome was assessed clinically, radiologically and functionally using the Olerud score.

The results showed that anatomical reduction was significantly less reliable (p = 0.03) and loss of reduction significantly more common (p = 0.001) in the group with closed treatment. Those managed by open reduction and internal fixation had a significantly higher functional outcome score (p = 0.03) and a significantly better range of movement of the ankle (p = 0.044) at review.