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Comparative Outcomes of Fully Threaded Headless Compression Screws and Partially Threaded Screws in Medial Malleolus
Ward Hamsho1, Muhammad Y Raufi2, Mohamed Elgendy3
1Trauma and Orthopaedics, Leeds Teaching Hospitals NHS Trust, Leeds, GBR.
None:
Medial malleolus fractures are common injuries, and screw fixation is the standard treatment. The choice between fully threaded headless compression screws (FTHCSs) and partially threaded screws (PTSs) remains controversial, particularly regarding soft-tissue irritation and reoperation rates. This systematic review and meta-analysis aimed to compare the clinical and functional outcomes of FTHCSs versus PTSs for medial malleolus fracture fixation. This review was conducted according to the PROSPERO protocol (Registration ID: CRD420251170989) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic search identified comparative studies evaluating FTHCSs against PTSs for medial malleolus fractures. Data, including functional scores of the American Orthopaedic Foot and Ankle Society (AOFAS), symptomatic hardware and implant removal, were pooled using a random-effects model. Dichotomous data were analyzed using risk ratios (RRs), and continuous data using mean differences (MDs), with 95% confidence intervals (CIs). Heterogeneity was assessed using the I² statistic. Risk of bias was assessed using the MINORS tool. Three retrospective comparative studies, including 146 patients (72 FTHCSs, 74 PTSs), were included. The pooled analysis showed a borderline statistically significant trend favouring FTHCSs for functional outcome (AOFAS score: MD = 1.64, 95% CI: -0.01, 3.28; P=0.05). However, FTHCSs significantly reduced the risk of symptomatic hardware (RR = 0.17, 95% CI: 0.08, 0.38; P < 0.0001) and the risk of implant removal (RR = 0.10, 95% CI: 0.02, 0.51; P = 0.006). All studies reported a 100% union rate in both groups. Two studies reported significantly lower post-operative pain (VAS) in the FTHCS group. Heterogeneity was low for all pooled outcomes (I²=0%). FTHCS fixation for medial malleolus fractures is associated with a significantly lower risk of symptomatic hardware and subsequent implant removal compared to PTSs, with comparable union rates and functional outcomes. Given the high rate of secondary procedures associated with PTSs, FTHCSs may be the preferred implant for medial malleolus fixation. The overall quality of evidence is low due to the inclusion of only retrospective studies.
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