These fractures should be properly reduced to achieve good results in terms of stability, function and pain relieve. In particular, the varus displacement needs to be corrected in order to prevent secondarily increased varus collapse or implant failure. These fractures are generally unstable after reduction (disimpaction), especially if the medial hinge is disrupted.
Operative fixation is the preferred treatment. However, the decision for surgery should also include the functional demands of the patients, the presence of comorbidities, and the ability to undergo operative treatment.
Indications for arthroplasty are inability to achieve stable fixation, especially in elderly patients with osteoporotic bone.