The aim of the present study was to evaluate the clinical and radiologic results of surgically treated isolated medial malleolar fractures and compare the clinical and radiologic results of the fixation methods of headless cannulated fully threaded compression screws and cancellous lag screws and tension band wiring. We included 32 patients who attended the final follow-up examination. Group 1 consisted of 11 patients (34.4%) treated with headless cannulated fully threaded compression screws. Group 2 consisted of 10 patients (31.2%) treated with cancellous lag screws. Group 3 consisted of 11 patients (34.4%) treated with Kirschner wires and intraosseous tension wiring. Standard ankle radiographs, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, and visual analog scale for pain were assessed. No statistically significant differences were found among the groups in regard to age, gender, preoperative fracture type, follow-up time, radiologic bone union time, and baseline AOFAS scale scores. The interval to fracture healing was 2.2 ± 0.42 months in group 1, 2.5 ± 0.71 months in group 2, and 2.45 ± 0.52 months in group 3. The AOFAS ankle-hindfoot scale score was 96.73 ± 5.55 in group 1, 93.1 ± 5.43 in group 2, and 93.73 ± 5.52 in group 3. Hardware removal was not required in any patient in group 1 but was required in 2 patients (20%) in group 2 and 3 patients (27.3%) in group 3. The visual analog scale score for pain on palpation at the medial malleolus was significantly lower statistically in the headless compression screw group (group 1; p = .003).
Level of Clinical Evidence
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to The Journal of Foot and Ankle Surgery
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Incarceration of the posterior tibial tendon in an isolated comminuted medial malleolus fracture.J Foot Ankle Surg. 2017; 56: 1312-1315
- Contribution of the deltoid ligament to ankle joint contact characteristics: a cadaver study.Foot Ankle Int. 1996; 17: 317-324
- Treatment of medial malleolus or pure deltoid ligament injury in patients with supination-external rotation type IV ankle fractures.Orthop Surg. 2017; 9: 42-48
- Sled fixation for horizontal medial malleolus fractures.Clin Biomech (Bristol, Avon). 2017; 42: 92-96
- Conservative treatment of isolated fractures of the medial malleolus.J Bone Joint Surg Br. 2007; 89: 89-93
- Nonoperative treatment of the medial malleolus in bimalleolar and trimalleolar ankle fractures: a randomized controlled trial.J Orthop Trauma. 2013; 27: 633-637
- Medial malleoli fractures: clinical comparison between newly designed sled device and conventional screws.Foot Ankle Spec. 2017; 10: 296-301
- Modified tension band wiring of medial malleolar ankle fractures.Foot Ankle Int. 1995; 16: 64-68
- Tension band fixation of medial malleolus fractures.J Orthop Trauma. 1992; 6: 464-468
- A clinical evaluation of alternative fixation techniques for medial malleolus fractures.Injury. 2014; 45: 1365-1367
- Anterograde headless cannulated screw fixation in the treatment of medial malleolar fractures: evaluation of a new technique and its outcomes.Med Princ Pract. 2016; 25: 429-434
- Biomechanical performance of a new device for medial malleolar fractures.Foot Ankle Int. 2013; 34: 426-433
- Reliability and validity of the subjective component of the American Orthopaedic Foot and Ankle Society clinical rating scales.J Foot Ankle Surg. 2007; 46: 65-74
- Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes.Foot Ankle Int. 1994; 15: 349-353
- Contribution of the medial malleolus to tibiotalar joint contact characteristics.Foot Ankle Spec. 2015; 8: 23-28
- Lag screw fixation of medial malleolar fractures: a biomechanical, radiographic, and clinical comparison of unicortical partially threaded lag screws and bicortical fully threaded lag screws.J Orthop Trauma. 2012; 26: 602-606
- Bicortical fixation of medial malleolar fractures: a review of 23 cases at risk for complicated bone healing.J Foot Ankle Surg. 2012; 51: 39-44
- Arthroscopic assessment of medial malleolar reduction.Arch Orthop Trauma Surg. 2014; 134: 1287-1292
- Evaluation of a new method of small fragment fixation in a medial malleolus fracture model.J Orthop Trauma. 2000; 14: 420-425
- Comparison of pullout strength between 3.5-mm fully threaded, bicortical screws and 4.0-mm partially threaded, cancellous screws in the fixation of medial malleolar fractures.J Foot Ankle Surg. 2010; 49: 248-252
- Fixation of the medial malleolar fracture: a simplified technique.J Foot Ankle Surg. 2008; 47: 368-371
- Treatment of medial malleolar fractures using fine-threaded K-wires: a new operative technique.J Trauma. 2007; 62: 258-261
- Medial malleolar fixation with a bicortical screw: technique tip.Foot Ankle Int. 2008; 29: 1151-1153
- Medial malleolar fractures: a biomechanical study of fixation techniques.Orthopedics. 2011; 34: 349-355
- Antiglide plating of vertical medial malleolus fractures provides stiffer initial fixation than bicortical or unicortical screw fixation.Clin Biomech (Bristol, Avon). 2016; 31: 29-32
- Comparison of tension band wire and cancellous bone screw fixation for medial malleolar fractures.J Foot Ankle Surg. 1997; 36: 284-289
Published online: March 15, 2018
Financial Disclosure: None reported.
Conflict of Interest: None reported.
© 2017 by the American College of Foot and Ankle Surgeons. All rights reserved.