Medial Malleolus fracture fixation by Screw fixation and Tension band wiring methods

Objectives: To compare the outcome of Internal fixations of Medial malleolus fracture by Simple screw fixation and Tension band wiring methods.

Patients and methods: This study was undertaken in 22 patients in two groups of 11 each, between 15 years-60 years. The first group patients were treated by Malleolar screw fixation while second one by Tension band wiring after matching for age, gender, fracture type, as well as the reasons of their fractured Medial Malleolus. Mean time for follow up was 15 months (9 months-21 months) Results: Radiological bone union took an average of 11.9 weeks in the first group, while 9.5 weeks in the second group (P=0.03)

The scores of the parameters like Pain, Stiffness, Swelling, Stair Climbing, Running, Jumping, Squatting, Support and Work or ADL were analyzed. Pain, Stiffness, Swelling, Stair Climbing was found significantly better in group 1 than group 2. While the scores of the parameters like Running, Jumping and Squatting did not show statistical significance (P>0.005), but their mean score were higher in group 2 as compared to Group 1.

None of the patients showed any sign of fixation failure or Kirschner wires migration

Excellent 4(36.3%), good 4 (36.3%), fair 2(18.1%) and poor 1(9%) scores were found in Malleolar screw fixation group patients while excellent 8 (72.7%), good 2 (18.18%), fair 1(9%) and poor 0 (0%) scores were found in Tension band wiring group according to modified ankle scoring system of Olerud and Molander. By applying test of significance, p was found to be not significant, P=0.388 by using Fisher’s Exact test in “R-Studio software”.

Conclusions: This comparative study showed that internal fixation of Medial Malleolar fractures result was better by tension wiring methods than screw fixation method if bone reunion is considered but by Modified ankle scoring system of Olerud and Molander no significant difference was observed by applying Fisher’s Exact test in “R-Studio software” p=0.388. But after comparing the scores of the parameters like Pain, Stiffness, Swelling, Stair Climbing, running, jumping, squatting, support and work or ADL, Pain, Stiffness, Swelling, Stair Climbing significantly better in group 1 than group 2. While the scores of the parameters like Running, Jumping and squatting did not show statistical significance (P>0.005), but their mean scores were higher in group 2 as compared to Group 1.

In Clinical and functional evaluation by Modified ankle scoring system of Olerud and Molander if we combine excellent (>90) good (81-90) scores, in Group 1, 90.88% showed execellent good score, while group 2 showed lesser percentage (72.6%) in this category. Fair (71-80) poor (<70) was found in 9% individuals in group 1 while 27.18% in group 2, according to modified ankle scoring system of Olerud and Molander. Recommendations: Further study is needed on a large number of cases for a longer duration of follow-up by allocation of the subjects through Randomized control trial, to arrive to the above conclusion.