Comparative study of operative fixation of fracture of medial malleolus by malleolar screw versus tension band wiring

Abstract

Background: Ankle fractures are common and many require surgical intervention. It has been well documented that type of surgery and a delay in fracture fixation results in increased length of hospital stay and increased complication rate. Initial delay can also allow swelling or blistering to develop which may necessitate a further delay in operative fixation up to 10 days and increase morbidity. Patients and Methods: A prospective study of twenty-one patients presented with displaced closed fracture of medial malleolus and treated surgically at AL-KARKH Hospital from March 2010 to September 2011; the fractures had been fixed by tension-band wiring or by malleolar screw. The patients were then classified into two groups (15 patients in group 1 were treated by tension-band wiring, figure of eight, and 6 patients in group 2 were treated by malleolar screw fixation). The patients were evaluated clinically, radiologically, and functionally with follow-up till complete healing. Results: Radiological union took place in the group 1 patients (mean time 10.2 weeks) earlier than in group 2 patients (mean time 12.2 weeks) with p=0.001. Excellent and good functional results were achieved in 73% in group 1 patients and in 66.7% in group 2 patients with p=0.034. A better range-of-motion (especially for dorsiflexion of ankle) was noticed in the group 2 patients. Conclusions: Tension-band wiring may be more valid and excellent option than the malleolar screw for internal fixation of fracture of medial malleolus, as it is more stable fixation than malleolar screw, and allows early active exercises of the ankle and these results have to be supported by studies of larger number of cases and longer follow-up duration, and application of other methods of internal fixation, before recommending the optimum method for ankle fracture fixation.