Trial lecture as part of a habilitation procedure in orthopeadic surgery and traumatology of the Musculo-skeletal system.

Summary: Conservative treatment in orthopedic surgery receives insufficient attention, particularly for malleolar fractures—the most common fractures of the foot and ankle (incidence of 16,500 cases/year in CH). Given that postoperative complication rates can reach up to 10%, this translates to 1,650 complications annually.
To reduce these complications while still achieving favorable clinical outcomes, a thorough re-evaluation of treatment approaches is necessary. A comprehensive, multidirectional research strategy should be adopted.
Research on non-operative management primarily focuses on the most prevalent fracture pattern, namely supination–external rotation (SER) fractures as defined by the Lauge–Hansen classification. The SER fracture group is further subdivided based on the specific anatomical structures involved, a distinction that is critical for determining fracture stability and guiding treatment strategies. Cadaveric studies form the foundation of this approach by providing essential biomechanical insights that support the development of safe and evidence-based treatment protocols. Treatment algorithms may subsequently be evaluated using a range of outcome measures, including objective gait analysis and validated patient-reported outcome measures.
In more complex fracture patterns, non-operative management is generally contraindicated. Nevertheless, comparative evaluation of outcomes with complex malleolar fractures and other severe foot and ankle injuries, such as pilon fractures, remains clinically relevant. In these injuries, radiographic progression of osteoarthritis does not necessarily correlate with clinical symptomatology, rendering long-term outcome prediction particularly challenging. Functional impairments, including restricted range of motion and chronic pain, may substantially diminish quality of life even in the absence of advanced radiographic joint degeneration. Accordingly, contemporary research increasingly emphasizes patient-centered outcome measures.