Medial Malleolus Fracture Fixation in Weber Type B and C Ankle Injuries

Abstract

Introduction: Medial malleolus fractures are commonly encountered by orthopaedic surgeons in their daily practice. Medial malleolus fractures are articular fractures and hence need anatomical reduction to prevent the potential complications. Many methods of fixation are in practice for fixing medial malleolus with the aim to achieve stable fixation and union of the fracture site. Aim: To evaluate the outcome of medial malleolus fracture fixation by three different methods- two partially threaded screws, one partially threaded screw and one k-wire and tension band wiring, in Weber type B and C ankle injuries. Materials and Methods: This prospective interventional study was conducted from August 2017 to September 2020 in a tertiary care orthopaedics hospital in Srinagar, Jammu and Kashmir, India. A total of 40 patients (aged 18 years or greater) of Weber B and C types medial malleolus fracture, were included in the present study. The medial malleolus was fixed with two partially threaded screws in 16 patients (Group A), one partially threaded screw and one Kirschner wire (K)-wire in 14 patients (Group B) and tension band wiring was done in 10 patients (Group C). The fixation was decided on intraoperative finding of fragment size and comminution as well as quality of bone. The parameters assessed were time of union, delayed union, non union, ankle range of motion and symptomatic hardware. One-way Analysis of Variance (ANOVA) test was used to compare parametric data of the three groups. The p-value <0.05 was considered statistically significant. Results: The mean age of the patients was 40.20 years with range 18-65 years. 22 patients were females and 18 were males and the male to female ratio was 0.81. The mean time of healing of fracture was 10.25 weeks in group A, 11.14 weeks in group B and 10.80 weeks in group C. There were two cases of delayed union, one each in group B and C. Symptomatic hardware was mostly seen in group C. There was no case of non union in the present study. Conclusion: It can be concluded that all the three fixation methods used in this study achieved the union in comparable time duration with no case of non union. A particular method of fixation should be used by taking into consideration the type of fracture, size of the fragment, comminution and quality of the bone.