Comparison of Fully Threaded Cannulated Screw, Half Threaded Cannulated Screw, and Tension-Band Wiring in the Fixation of Herscovici Type C Medial Malleolus Fractures: A Retrospective Clinical Study

OpenAlex İngilizce

Objective: Surgical treatment is often preferred for medial malleolus fractures to achieve anatomic reduction and enable early mobilization.This study aims to evaluate the clinical and radiological outcomes of fixing Herscovici Type C medial malleolus fractures using tensionband wiring (TBW) and half and fully threaded cannulated screws.Methods: This retrospective study included patients aged 18 to 65 who underwent surgery for isolated medial malleolus fractures between January 2012 and December 2022.Exclusion criteria were a follow-up period of less than one year, fractures other than Herscovici Type C, open fractures, use of other implants, or loss to follow-up.Radiological evaluations were conducted using preoperative anterior-posterior, lateral, and mortise radiographs, along with computed tomography scans.The talocrural angle, corner angle, and alignment between the talus and tibial plafond were assessed.Clinical outcomes were measured using the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale.Statistical analysis was performed using SPSS software.Results: A total of 178 patients were included: 55 (30.9%) underwent TBW fixation, 60 (33.7%) had half-threaded cannulated screw fixation, and 63 (35.4%) received fully threaded cannulated screw fixation.The mean follow-up period was 76 months, and the mean age was 32.2 years.The TBW group had a significantly longer follow-up period than the other groups (p=0.000), with no difference between the half and fully threaded screw groups.There were no differences among the groups regarding fracture side, trauma mechanism, or need for implant removal.Postoperative talocrural angles were similar across groups (p=0.530).The postoperative corner angle was significantly lower in the TBW group (mean: 63.4) compared to the half-threaded (mean: 65.8) and fully threaded (mean: 65.2) screw groups (p=0.049).AOFAS scores were significantly higher in the half-threaded screw group (mean: 89.1) compared to the TBW (mean: 84.2) and fully threaded screw groups (mean: 85.9) (p=0.02).No significant difference was found between the half-threaded and fully threaded screw groups regarding the alignment between the superior facet of the talus and the anterior tibial plafond.The TBW group had a significantly higher number of patients with misaligned joints compared to the other groups (p=0.000).Conclusion: Radiological outcomes were better in the half and fully threaded cannulated screw fixation groups compared to the TBW fixation group.The AOFAS scores were highest in the half-threaded screw fixation group.No significant differences were found among the groups regarding complications.The study concludes that cannulated screw fixation is a safer and more effective method for treating isolated medial malleolus fractures than the TBW fixation method.