A Comparative Evaluation of Tension Band Wiring and Cannulated Cancellous Screw Fixation in Medial Malleolus Fractures

Background: Medial malleolus fractures are commonly encountered ankle injuries that can significantly compromise ankle stability and function. Proper anatomical reduction and stable internal fixation are essential to restore joint congruity, allow early mobilization, and prevent long-term complications such as post-traumatic arthritis. Among various fixation techniques, tension band wiring (TBW) and cannulated cancellous (CC) screw fixation are most frequently used. Objective: To compare the functional outcome, radiological union, and complication rates between tension band wiring and cannulated cancellous screw fixation in medial malleolus fractures. Materials and Methods: This prospective comparative study was conducted on 80 patients with medial malleolus fractures treated surgically. Patients were divided into two equal groups: Group A underwent fixation using tension band wiring, while Group B was treated with cannulated cancellous screws. Functional outcome was assessed using the Olerud-Molander Ankle Score (OMAS), and radiological union was evaluated through serial follow-up radiographs. Results: Fracture union was achieved in all patients. Both groups demonstrated good to excellent functional outcomes, with no statistically significant difference in OMAS scores. Implant irritation was more commonly observed in the TBW group, whereas delayed union was occasionally noted in the CC screw group. Conclusion: Both tension band wiring and cannulated cancellous screw fixation are effective treatment options for medial malleolus fractures. Selection of fixation method should be based on fracture configuration and fragment size to achieve optimal outcomes.