Comparing different fixation methods for medial malleolar ankle fractures

BACKGROUND: Medial malleolus fractures are common injuries. Although various fixation methods are used, the optimal technique remains a subject of debate. PURPOSE: This study aimed to compare complication rates associated with different fixation techniques for medial malleolar fractures and to evaluate whether fracture classification, implant size or number of screws influence outcomes. STUDY DESIGN: Retrospective cohort study. METHODS: A retrospective cohort study was conducted, analyzing clinical and radiographic data of 80 patients (82 ankles) treated surgically for medial malleolar fractures at a level 1 trauma center. The median follow-up time was 40 weeks (9 to 187 weeks). Fixation methods included plate fixation, screw fixation, screw fixation with K-wire, and tension band wiring. Complication rates (nonunion, infection, secondary dislocation, wound dehiscence) were compared across groups. RESULTS: The overall complication rate was 12.2% (10 of 82 ankles). Plate fixation demonstrated the highest complication rate (27.3%), with deep infection in 18.2% of cases, significantly higher compared to other fixation techniques (p = .012). No significant differences in complication rates were observed regarding the Herscovici classification for fracture types, implant size, or single versus double screw fixation. CONCLUSION: In conclusion, plate fixation was associated with a significantly higher risk of complications, particularly deep infection, compared to other fixation methods. These findings suggest that less invasive fixation techniques should be considered when feasible to minimize postoperative morbidity.