J Korean Foot Ankle Soc.  2024 Dec;28(4):152-156. 10.14193/jkfas.2024.28.4.152.

Comparison of Outcomes Using Cortical Lag Screws Versus Cancellous Position Screws for Fibula Fixation in Weber Type B Rotational Ankle Fractures

• Lee J
• Cho S
• Park JY

• KMID: 2562452
• DOI: http://doi.org/10.14193/jkfas.2024.28.4.152

Abstract

Purpose
Ankle fractures are common in the orthopedic field. Lateral malleolar fractures are often treated with lag screws and locking plates. Cortical screws are typically used as lag screws to achieve absolute stability through compression. In osteoporotic bone, however, achieving sufficient compression with cortical screws can be challenging. Cancellous screws may offer better fixation in metaphyseal bone. This study compared the outcomes of using cortical screws as lag screws and cancellous screws as position screws for lateral malleolar fixation.
Materials and Methods
This retrospective study included patients who underwent surgery for Weber type B ankle fractures at the authors’ hospital between March 2019 and March 2022. The patients were divided into two groups based on the screw type: cortical lag screws (n=70) and cancellous position screws (n=35). In both groups, a locking plate was applied in the same manner after screw fixation. The outcomes were evaluated using the visual analog scale (VAS), Olerud-Molander score (OMS), foot and ankle outcome score (FAOS), and foot function index (FFI). Complications, such as fixation failure, nonunion, and malunion, were recorded.
Results
One hundred and five patients were included. The mean follow-up duration was 16 months (range, 12~28 months). The VAS (1.6±1.9 vs. 1.1±1.3, p=0.305), FFI (10.3±13.4 vs. 10.4±13.5, p=0.970), FAOS (83.0±14.4 vs. 83.5±14.4, p=0.899), and OMS (85.3±18.4 vs. 84.7±17.6, p=0.910) scores were similar in the two groups. No complications were reported in either group.
Conclusion
For the fixation of Weber B fibular fractures, cortical lag screws and cancellous position screws showed comparable clinical outcomes. Cancellous screws with plate fixation may offer a viable alternative in cases with poor bone quality or difficulty applying lag screw techniques.

Keyword

Ankle fracture; Lateral malleolus fracture; Bone screw; Cancellous bone

Figure

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  Figure 1 (A) Preoperative, (B) immediate postoperative, and (C) 1 year and 3 months postoperative radiographs of the 44-year-old male patient with bimalleolar fracture. A cortical screw was used in the lag screw technique for the lateral malleolar fixation.

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  Figure 2 (A) Preoperative, (B) immediate postoperative, and (C) 1 year and 4 months postoperative radiographs of the 69-year-old female patient with trimalleolar fracture. A cancellous screw was used as a position screw for the lateral malleolar fixation.

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