Unicortical Versus Bicortical Screw Fixation for Medial Malleolus Fractures: A Retrospective Comparative Study

Ankle fractures are common lower extremity injuries often involving the medial malleolus, a critical stabilizer of the ankle mortise. Screw fixation is the standard treatment, but the choice between unicortical and bicortical screw techniques remains debated. This retrospective study evaluates clinical outcomes of unicortical versus bicortical screw fixation in medial malleolus fractures over a four-year period at a Level 1 trauma center. In this study, 137 adult patients were included, with 95 undergoing unicortical fixation and 42 bicortical fixation. The primary outcome was early radiological union at three months. Delayed union rates were similar between groups (unicortical 9%, bicortical 7%, p=0.656). No significant differences in complications or secondary procedures were observed. Despite biomechanical advantages of bicortical screws, our data suggests comparable clinical effectiveness for both techniques. Further prospective studies with longer follow-up and functional outcomes are warranted.