Functional and Radiological Outcomes of Medial Malleolus Fracture Fixation Using Headless Compression Screws

TL;DR

This study shows that using headless compression screws for medial malleolus fractures leads to good recovery and reliable results compared to other methods.

Contribution

The study provides new evidence on the effectiveness of headless compression screws for medial malleolus fracture fixation.

Findings

78.7% of patients achieved excellent functional outcomes with AOFAS scores above 90.

38.2% of patients had excellent results in pain relief and radiological union with BJS scores over 95.

Headless compression screws provided stable fixation with favorable long-term outcomes.

Abstract

Introduction: Medial malleolar fractures frequently accompany ankle fractures and demand precise anatomical reduction for optimal outcomes. Several fixation techniques have been employed, including partially threaded unicortical lag screws, which, despite their ease of use, are associated with reduced torque resistance and increased screw loosening. Alternatively, partially threaded cancellous screws with or without washers have also been utilized to achieve stable fixation in medial malleolar injuries.

Objective: This study aimed to evaluate and compare the radiological and functional outcomes of medial malleolar fractures in ankle fracture cases managed using headless compression screw fixation.

Subjects and methods: A total of 47 patients were included in this retrospective study conducted over a 30-month period. Preoperative assessments included detailed clinical histories, injury mechanism analysis, and imaging investigations. Postoperative follow-up extended to 30 months. Clinical outcomes were assessed using the Baird and Jackson Scoring System (BJS) and the American Orthopaedic Foot and Ankle Society (AOFAS) Hindfoot Score.

Results: Among the 47 patients, 37 patients (78.7%) achieved AOFAS scores above 90, reflecting excellent functional outcomes, while 10 patients (21.3%) scored between 80 and 90, indicating good results. Additionally, 18 patients (38.2%) attained BJS scores greater than 95, corresponding to excellent outcomes in terms of pain relief, mobility, and radiological union.

Conclusion: Headless cannulated compression screw fixation demonstrates high efficacy in the treatment of medial malleolar fractures, offering a reliable alternative to conventional fixation techniques with favourable radiological and functional outcomes.

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