Results of fixation of medial malleolus fractures with closed versus open reduction

Background: Medial malleolus fractures are common ankle injuries with varied treatment approaches, most notably closed and open reduction techniques. Each method presents distinct outcomes and complication profiles. The study aimed to investigate and compare the clinical and radiological outcomes of both techniques in a local context and in comparison, with international literature. Methods: A prospective-retrospective study was conducted at Aleppo University Hospital, orthopedic surgery Branch, between January 2020 and January 2025. A total of 67 patients with medial malleolar fractures were included. Patients underwent closed or open reduction based on clinical judgment. Data were collected via clinical examination, medical history, radiological, and laboratory investigations. Outcomes and complications were statistically analyzed. Results: The non-union rate was higher in the open reduction group (7.7%) than in the closed group (2.4%), but this was not statistically significant. However, the mean union time was significantly longer in the closed reduction group (14.6 weeks vs. 11.5 weeks, p=0.041). Complications such as infection, nerve injury, malunion, and joint stiffness were more frequent in the open reduction group. Secondary displacement and Sudeck’s atrophy were more frequent in the closed group, although none of these differences were statistically significant. Conclusions: While both open and closed reduction techniques are effective in managing medial malleolus fractures, open reduction is associated with a higher rate of complications despite shorter union time. Closed reduction may be preferable in selected patients due to its favorable complication profile. These findings align with international data, although variations exist depending on study settings and sample characteristics.