Clinical Outcomes of Fibula Fractures Fixed With Clamp Compression and Positional Screws Versus Lag Screws-Is There a...

Area of Science:

• Orthopedic surgery
• Traumatology
• Biomechanical engineering

Background:

• Lag screws (LSs) offer compression but have limitations in certain bone qualities or fracture configurations.
• Clinical superiority of LSs over clamp compression and positional screw (PS) fixation for fibular fractures is not established.
• Fibular fractures represent a common orthopedic injury requiring effective surgical management.

Purpose of the Study:

• To compare the clinical outcomes of fibular fractures treated with lag screws (LSs) versus clamp compression and positional screw (PS) fixation.
• To evaluate the union rates and revision surgery rates associated with each fixation technique.
• To determine if PS fixation is noninferior to LS fixation for lateral malleolus fractures.

Main Methods:

• A retrospective review of 189 patients (age >18) undergoing surgical fibula fixation between 2015 and 2020.
• Patients with interfragmentary screw fixation and a minimum 6-month follow-up were divided into LS and PS groups.
• Demographic and clinical data were analyzed, comparing union and revision rates between the two groups.

Main Results:

• Both LS and PS fixation achieved a 100% union rate.
• The revision surgery rate was higher in the LS group (10.5%) compared to the PS group (3.6%), though not statistically significant (P=0.072).
• Groups were comparable in age, sex, diabetes, and smoking status.

Conclusions:

• Interfragmentary PS technique, utilizing clamp compression and PS, is noninferior to LS fixation for lateral malleolus fractures.
• The PS technique demonstrates high union rates and a trend towards lower revision surgery rates.
• PS fixation presents a clinically feasible and effective alternative for fibular fracture management.