Retrograde intramedullary headless compression screw fixation for distal fibular fractures

Although intramedullary headless compression screw fixation for distal fibular fractures has been described, its biomechanical properties remain underexplored in orthopedic literature. Distal fibular fractures are commonly treated with plate-and-screw constructs; however, complications related to hardware prominence, soft tissue irritation, and hardware removal are frequent. Retrograde intramedullary headless compression screw fixation may offer a biomechanically stable, minimally invasive alternative.

To biomechanically compare retrograde intramedullary headless compression screw fixation with traditional 7-hole one-third tubular plate and lag screw fixation in simulated Weber B distal fibular fractures using cadaveric models.

Twenty match-paired cadaver fibulas were artificially fractured and repaired with either intramedullary screw or plate fixation. The specimens underwent four-point bending and torsional tests to assess biomechanical stability. Paired t-tests were used for comparisons, with effect sizes and confidence intervals reported.

Intramedullary headless compression screw fixation demonstrated greater stability during compression testing, but this difference was not statistically significant (p = 0.1326). The mean difference in maximum compressive load was 28.108 N (95 % CI [-11.43, 67.65]). No significant differences were observed in torsion testing, with a mean difference of -14.411 N·cm (95 % CI [-35.70, 6.88]). The study had low statistical power (0.052) to detect differences.

Retrograde intramedullary screw fixation provides comparable or superior biomechanical stability to plate-and-screw constructs in a cadaveric model. This technique may be a viable alternative in select fracture patterns, warranting further clinical investigation.