Antegrade screw fixation for reverse oblique fractures of the medial malleolus

Abstract

Objective: To assess the safety and effectiveness of antegrade minifragment lag screws in patients with reverse obliquity medial
malleolar fractures. Methods: A retrospective case series was conducted at a tertiary care institution between January 2019 and December 2024. Eligibility criteria included skeletally mature patients with reverse oblique medial malleolar fractures identified by radiographs and computed tomography, treated with antegrade minifragment screws. Functional outcomes were assessed using the AOFAS ankle-hindfoot score and the Olerud-Molander ankle score. Results: Over the study period, two fellowship-trained orthopedic trauma surgeons performed 177 malleolar fracture fixations, of which 84 involved the medial malleolus. Six patients presented with the reverse oblique fracture configuration, all resulting from torsional trauma. All medial malleolar fractures achieved complete union without adverse events, with consolidation occurring within six weeks at the latest. After healing, no patient reported pain around the medial malleolus or implant-related discomfort. Conclusion: The use of bicortical antegrade minifragment screws resulted in functional outcomes comparable to those described for standard fixation methods, without complications such as loss of reduction, nonunion, or malunion. Although the small sample size limits the external validity of the findings, the favorable results suggest that this technique may represent a viable alternative, especially in cases involving small fragments where bone preservation is essential.
Level of Evidence IV; Case Series.