Comparative study of tension band wiring and malleolar screw fixation for the treatment of medial malleolus fracture

Abstract

Background: Malleolar fractures are the most common type of ankle fractures. These intra-articula fractures need to be managed properly as they have high chance of non-union and are usually treated operatively. Open reduction and internal fixation with malleolar screw or tension band wiring (TBW) are mostly used treatment modalities for medial malleolus fracture. The objective of this study was to compare the functional and radiological outcome of patient who underwent TBW or malleolar screw fixation. Methods: It was a prospective comparative study conducted in 40 patients at Gandaki Medical College over the period of 24 months. Patients fulfilling the inclusion criteria were included in in the study. 20 patients were randomly selected in either group of malleolar screw and TBW which were followed for six months postoperatively. Functional outcome was measured using Olerud and Molander scoring system. Radiological outcome, adverse radiological outcome, range of motion and complications were studied and compared. Results: The mean age of TBW group was 41.3± 14.76 while in malleolar screw group it was 39.65±15.34. Male to female ratio in TBW group and malleolar screw group was 0.82 and 0.66 respectively which is not statistically significant. Mode of injury, fracture type pre and postoperative hospital stay and duration of surgery were statistically similar in both the groups. Most common mode of injury was RTA (50%) and twisting of ankle (35%). Higher rate of smoking was seen in malleolar screw group(40%) than in TBW group(20%) while alcohol consumption was seen in 40% TBW patients and 15% malleolar screw patients. Average duration of bony union was significantly higher in TBW group (8.32±1.61 weeks) compared to malleolar screw fixation group (10.69±3.35weeks) (P=0.008), however there is no significant difference in term of functional outcome score, radiological outcome and complication rate. Conclusions: There is no significant difference in term of functional outcome and complication rate between TBW or malleolar screw fixation for medial malleolar fracture however, patients treated with TBW fixation tend to show earlier radiological union.