Antiglide Plate vs Horizontally Oriented Parallel Screws in Vertical Shear Medial Malleolus Fracture

Vertical shear medial malleolus fracture is less common than transverse. A plurality of methods is used for fixation, including lag screws, buttress plating, neutralisation plating with screws, and antiglide plating. But none of them has been proved to be the optimal choice. The study aimed to evaluate the clinical and functional findings and complications that might occur after vertical shear medial malleolus fracture fixation using either an antiglide plate or horizontally placed parallel screws oriented perpendicular to the fracture line.

A prospective cohort investigation included 56 cases with vertical shear medial malleolus fractures. The individuals were categorised into two divisions based on the fixation methods used: Antigliding plate (25 cases) or screws (31 cases). The median age in the antiglide plate division was 34 years (IQR: 23-50 years), while in the screws category, it was 38 years (IQR: 29.5-48 years). Functional outcomes were evaluated using the AOFAS score.

Operative time and incision length were substantially shorter in the screws category compared to the antiglide plate division (P _eff = 0.001 and p < 0.001, respectively) and union time was statistically shorter in the antiglide plate category compared to the screws division (P _eff = 0.019), no clinically or statistically significant difference was observed in functional outcomes based on the AOFAS score at 3-month and 1-year follow-ups.

In this type of ankle injury, the use of an antiglide plate or screws can provide nearly equal clinical and radiological outcomes, but with longer operative time and incision length towards the antiglide plate.