{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T11:10:06Z","timestamp":1756379406987,"version":"3.44.0"},"reference-count":18,"publisher":"BMJ","issue":"4","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2019,3,20]]},"published-print":{"date-parts":[[2019,4]]},"abstract":"<jats:p>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\u2009months. Nine months following an injury, he walks unaided, can squat and drive and has no medial pain or instability with an Olerud\u2013Molander 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.<\/jats:p>","DOI":"10.1136\/bcr-2018-228965","type":"journal-article","created":{"date-parts":[[2019,4,5]],"date-time":"2019-04-05T12:08:22Z","timestamp":1554466102000},"page":"e228965","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["To fix or not to fix: a novel approach to the safe management of unstable open medial malleolar fractures"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2883-371X","authenticated-orcid":false,"given":"Tom H","family":"Carter","sequence":"first","affiliation":[{"name":"Division of Health Sciences, University of Edinburgh, Edinburgh, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Calum HC","family":"Arthur","sequence":"additional","affiliation":[{"name":"Department of Edinburgh Orthopaedic Trauma, Royal Infirmary of Edinburgh, Edinburgh, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew D","family":"Duckworth","sequence":"additional","affiliation":[{"name":"Department of Edinburgh Orthopaedic Trauma, Royal Infirmary of Edinburgh, Edinburgh, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timothy O","family":"White","sequence":"additional","affiliation":[{"name":"Department of Edinburgh Orthopaedic Trauma, Royal Infirmary of Edinburgh, Edinburgh, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,4,3]]},"reference":[{"key":"2025082803514030000_12.4.e228965.1","doi-asserted-by":"crossref","first-page":"169","DOI":"10.2106\/00004623-197759020-00005","article-title":"The key role of the lateral malleolus in displaced fractures of the ankle","volume":"59","author":"Yablon","year":"1977","journal-title":"J Bone Joint Surg Am"},{"key":"2025082803514030000_12.4.e228965.2","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1016\/S0030-5898(20)31464-4","article-title":"The medial malleolus in ankle fractures","volume":"11","author":"Hughes","year":"1980","journal-title":"Orthop Clin North Am"},{"key":"2025082803514030000_12.4.e228965.3","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.E.00492"},{"key":"2025082803514030000_12.4.e228965.4","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1016\/j.fas.2016.06.004","article-title":"The functional outcome and quality of life after treatment of isolated medial malleolar fractures","volume":"23","author":"Hanhisuanto","year":"2017","journal-title":"Foot Ankle Surg"},{"key":"2025082803514030000_12.4.e228965.5","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1186\/1754-9493-5-24","article-title":"Preventing surgical complications: a survey on surgeons' perception of intra-articular malleolar screw misplacement in a cadaveric study","volume":"5","author":"Giordano","year":"2011","journal-title":"Patient Saf Surg"},{"key":"2025082803514030000_12.4.e228965.6","doi-asserted-by":"publisher","DOI":"10.1177\/1938640015583308"},{"key":"2025082803514030000_12.4.e228965.7","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.F.00689"},{"key":"2025082803514030000_12.4.e228965.8","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1097\/BOT.0b013e31828e1bb7","article-title":"Nonoperative treatment of the medial malleolus in bimalleolar and trimalleolar ankle fractures: a randomized controlled trial","volume":"27","author":"Hoelsbrekken","year":"2013","journal-title":"J Orthop Trauma"},{"key":"2025082803514030000_12.4.e228965.9","doi-asserted-by":"crossref","first-page":"1184","DOI":"10.2106\/00004623-198365080-00024","article-title":"Loss of the medial malleolus in a bimalleolar fracture. 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