Evolution of a traditional technique: Comparison of a 4-mm lag screw and Kirschner wire technique versus a 4-mm lag screw and Kirschner technique with anti-gliding miniplate fixation for the treatment of medial malleolar fractures

BACKGROUND: In this study, we aimed to compare a 4-mm lag screw and Kirschner wire technique versus a 4-mm lag screw and Kirschner wire (K-wire) technique with additional miniplate fixation for the treatment of medial malleolar fractures. METHODS: A total of 23 patients who were diagnosed with isolated fractures of the medial malleolus and operated in our center were retrospectively analyzed. The patients were divided into two groups: Group A, medial malleolar fracture fixed with a 4-mm cannulated screw and a K-wire (n=11) and Group B, a 4-mm cannulated screw and K-wire used for fixation with miniplate fixation for extra stability (n=12). Clinical outcomes were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score at 2, 6, 12, and 24 months postoperatively. At 12–24 months, the presence of pain and tenderness in the medial malleolus with palpation was evaluated using the visual analog scale (VAS) pain scores. RESULTS: The mean time to union was 2.23±0.56 (range, 1.8–2.9) months in Group A and 2.46±0.45 (range, 1.9–3.1) months in Group B, indicating no statistically significant difference between the two groups (p>0.05). The mean AOFAS score at 2 months postoperatively was 60.40±7.78 (range, 46–79) in Group A and 73.60±10.80 (range, 53–87) in Group B, indicating a statistically significant difference between the groups (p<0.01). However, there was no statistically significant difference in the mean AOFAS scores at 6 and 12 months between the groups (p>0.05). The mean VAS pain scores at 12–24 months postoperatively did not significantly differ between the groups (p>0.05). CONCLUSION: Our study results suggest that the treatment of medial malleolar fractures with a cannulated screw and K-wire with additional stabilization using a miniplate ensures favorable early outcomes with early return to daily living activities. However, both techniques have similar outcomes in the mid-term.