Lag Screw-Only Fixation for Simple Oblique Fibular Fractures: A Narrative Review

Background. Lag screw-only fixation has been proposed as a less invasive alternative to traditional plating for simple oblique fractures of the distal fibula. This technique may reduce hardware-related complications while maintaining adequate stability and promoting fracture healing. This review aims to assess whether a lag screw-only construct can provide sufficient stability and reduce complications commonly associated with traditional lag screw-plus plate fixation in patients with simple oblique distal fibular fractures. Methods. A narrative review of the literature was conducted through PubMed, Embase, and the Cochrane Library. Studies were included if they reported clinical or biomechanical outcomes of lag screw-only fixation in simple oblique fibular fractures. Biomechanical studies and editorials relevant to the technique were also reviewed for context. Results. Eight clinical and 6 biomechanical studies were identified. Patients included primarily presented with Lauge-Hansen SER-type fractures without comminution. Across studies, lag screw-only fixation demonstrated 100% union rates, with clinical and functional outcomes comparable to traditional plating. Validated scores such as Olerud and Molander (OM), Foot and Ankle Ability Measure (FAAM), and Single Assessment Numeric Evaluation (SANE) indicated excellent postoperative function. Complication rates were generally low. Biomechanical models suggested similar stability to plating. Early mobilization and weightbearing were rarely implemented, with only a letter to the editor suggesting their safety. Conclusion. For selected cases, lag screw-only fixation may be a viable option in the treatment of distal fibular fractures. However, current evidence remains limited and heterogeneous. Further studies are needed to validate its safety and suitability for early rehabilitation protocols. This study is designed as a narrative review. Levels of Evidence: V