Publication:

Comparative analysis of tension band wiring and cannulated cancellous screws for displaced medial malleolus fractures: a prospective study

Background The displaced medial malleolus fractures require surgical intervention, and the management includes tension band wiring (TBW) and cannulated cancellous screws (CCS).

Methods This prospective randomized study was conducted from December 2019 to December 2022. Sixty patients with closed displaced medial malleolus fractures were randomized into two groups: group A (TBW) and group B (CCS). Patients were evaluated based on radiological fracture union and functional outcomes assessed using the modified Olerud and Molander ankle score (OMAS). Follow-ups were conducted for two years to assess healing, range of motion, complications, and functional outcomes.

Results Mean age was 41.46 years in group A (TBW) and 39.4 years in group B (CCS). Radiological union was achieved faster in group B (10.4 weeks) compared to group A (11.53 weeks, p=0.003). Functional outcomes showed excellent scores in 16.67% of group A patients and 30% of group B patients. Group B had fewer complications, with only one case of screw loosening compared to a higher rate of hardware prominence (30%) and exertional pain (10%) in group A, necessitating implant removal in 12 patients. No significant differences in range of motion were observed, although group B demonstrated slightly better functional outcomes.

Conclusions Both TBW and CCS effectively achieve fracture union in displaced medial malleolus fractures. However, CCS fixation demonstrates superior functional outcomes, faster union rates, and fewer complications compared to TBW. Lower risk of hardware-related issues and reduced need for secondary surgeries, CCS is recommended as a preferred method for the surgical management of displaced medial malleolus fractures.