title: A clinical evaluation of alternative fixation techniques for medial malleolus fractures.
abstract: BACKGROUND
  Medial malleolus fractures have traditionally been managed using partially threaded screws and/or Kirschner wire fixation. Using these conventional techniques, a non-union rate of as high as 20% has been reported. In addition too many patients complaining of prominent hardware as a source of pain post-fixation. This study was designed to assess the outcomes of medial malleolar fixation using a headless compression screw in terms of union rate, the need for hardware removal, and pain over the hardware site.
  
  
  METHODS
  Saint Louis University and Mercy Medical Center, Level 1 Trauma Centers, St. Louis, MO.
  
  
  METHODS
  After IRB approval, we used billing records to identify all patients with ankle fractures involving the medial malleolus. Medical records and radiographs were reviewed to identify patients with medial malleolar fractures treated with headless compression screw fixation. Our inclusion criteria included follow-up until full weight bearing and a healed fracture. Follow-up clinical records and radiographs were reviewed to determine union, complication rate and perception of pain over the site of medial malleolus fixation. Sixty-four ankles were fixed via headless compression screws and 44 had adequate follow-up for additional evaluation.
  
  
  RESULTS
  Seven patients had isolated medial malleolar fractures, 23 patients had bimalleolar fractures, and 14 patients had trimalleolar fractures. One patient (2%) required hardware removal due to cellulitis. One patient (2%) had a delayed union, which healed without additional intervention. Ten patients (23%) reported mild discomfort to palpation over the medial malleolus. The median follow-up was 35 weeks (range: 12-208 weeks). There were no screw removals for painful hardware and no cases of non-union.
  
  
  CONCLUSIONS
  Headless compression screws provide effective compression of medial malleolus fractures and result in good clinical outcomes. The headless compression screw is a beneficial alternative to the conventional methods of medial malleolus fixation.
authors.affiliation: Department of Orthopaedic Surgery, Saint Louis University Medical Center, St. Louis, MO, USA.
authors.forename: Hayley
authors.initials: H
authors.lastname: Barnes
authors.affiliation: Department of Orthopaedic Surgery, Saint Louis University Medical Center, St. Louis, MO, USA. Electronic address: lcannada@slu.edu.
authors.forename: Lisa K
authors.initials: LK
authors.lastname: Cannada
authors.affiliation: Department of Orthopaedic Surgery, Saint Louis University Medical Center, St. Louis, MO, USA.
authors.forename: J Tracy
authors.initials: JT
authors.lastname: Watson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D064386:Ankle Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D000843:Ankle Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001696:Biomechanical Phenomena; D001863:Bone Screws; D001864:Bone Wires; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal; D017102:Fracture Healing; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain; D011859:Radiography; D014193:Trauma Centers; D016896:Treatment Outcome; D014481:United States; D016474:Weight-Bearing
keywords: Ankle fracture; Fracture; Headless compression screw; Medial malleolus