Fixation of choice for transverse fractures of medial malleolus of ankle

Abstract

Background: Fixation of choice for transverse fractures of medial malleoli has always been a debate as most of the times the fragment is too small to achieve placement of two screw heads. Absolute stability of the medial malleolar fragment with a single screw is difficult in comminuted and osteoporotic fragments. Materials and Methods: This is a prospective study conducted in our centre from November 2013 to May 2017 in 97 cases. Results: There was a failure of 3 cases of fixation with single screw out of 16 cases of primary fixation with single screw, contributing to 18.75% of cases of failure with primary single screw fixation. Conclusion: We advise to fix two screws of 4.0mm cannulated cancellous screws crossing the fracture site if the fragment is large enough to support screw heads. If the fragments are small we prefer to do a tension band wiring with two K-wires and a transverse screw which we had done in 55.7% of cases as a primary procedure. All three failure cases in our series achieved union with tension band wiring.