Comparison of outcome of 4mm cancellous screws versus tension band wiring in patients with medial malleolar fractures
1Dr Muhammad Asim Munir Qureshi, 2Dr Zahid Munir , 3Dr Ammad Ahmed , 4Dr Ahmad Raza Choudhry ,
Submission: 01 December 2025 | Acceptance: 08 January 2026 | Publication: 28 January 2026
1Senior Registrar Lahore General Hospital Lahore.
2,3,4Mayo Hospital Lahore.
ABSTRACT
INTRODUCTION: Medial malleolus fracture is commonly seen nowadays in orthopaedic practice. There are different modalities of treatment based on fracture pattern, socio-economic status. Un-displaced fracture can be managed by cast application. Various surgical modalities of treatment are available in treating medial malleolus fracture like tension band wiring, cancellous screw or cortical screw fixation, plate fixation, k-wire, suture anchors. The purpose of our study was to compare functional outcome of medial malleolar fracture managed with tension band wiring and cancellous screw fixation.
OBJECTIVE: To compare the outcome of 4mm cancellous screws versus tension band wiring in patients with medial malleolar fractures (supination-external rotation type-III and IV).
STUDY SETTING: The study was conducted in Orthopaedic Unit-I, Mayo Hospital, Lahore.
DURATION OF STUDY: March 16, 2021 to September 16, 2021.
STUDY DESIGN: Randomized controlled trial.
SUBJECTS & METHODS: Total 114 patients (57 in each group) having supination-external rotation fractures were enrolled. The patients were randomly divided into two treatment groups using lottery method as follows. Group A= 4mm cancellous screws and Group B= tension band wiring.The patients were evaluated functionally using a modification of the scoring system Proposed by Olerud and Molander. The data were analyzed by SPSS v25.0. Chi-square test was used to compare the outcome in two groups. Data were stratified for gender, age, type of fracture and BMI. Post-stratification, Chi-square test was applied. A p-value ≤0.05 was considered as significant.
RESULTS: Total 114 patients having Supination-External rotation fractures (Lauge-Hansen classification) were enrolled in this study. Patients were divided into two groups i.e. Group-A (Malleolar screw) and Group-B (Tension band wiring).Mean age in group-A patients was 43.02±15.55 year and 44.28±14.05 year in group-B patients. According to functional outcome, in Malleolar screw group, 22(38.6%) had excellent outcome, while 12(21.1%), 19(33.3%) and 4(7.0%) had good, fair and poor outcomes respectively, while in Tension band wiring group, 38(66.7%) had excellent outcome, while 11(19.3%), 6(10.5%) and 2(3.5%) had good, fair and poor outcomes respectively with a p-value of 0.008, which is statistically significant.
CONCLUSION: Tension-band wiring more valid option for internal fixation of medial malleolar fractures and more technically advantageous for small fragment fixation of medial malleolar fractures. The tension-band wiring may be more available and its usage could translate into overall cost saving when applied to the large number of ankle fractures treated surgically.
KEY WORDS:Ankle Fracture, Tension Band Wiring, Malleolar Screw, Modified Olerud and Molander Ankle Score.