Short-Term Outcome of Tension Band Wiring for Medial Malleolar Fractures

The structural integrity of the medial malleolus is critical for maintaining the stability of the ankle mortise. While various internal fixation strategies exist, tension band wiring (TBW) leverages the principle of dynamic compression by converting tensile forces into compressive forces during early mobilization. This technique remains highly relevant in clinical practice, particularly for addressing small fracture fragments and transverse patterns.

This prospective observational study evaluated 20 skeletally mature patients presenting with closed Herscovici Types A, B, and C medial malleolar fractures. Surgical intervention used a standard medial approach, achieving anatomical reduction with two parallel Kirschner wires and a stainless-steel wire loop applied in a figure-of-eight configuration. Clinical outcomes were monitored over a 6-month follow-up period.

The patient cohort demonstrated a mean age of 33.05 ± 11.2 years and was predominantly male (70%). Road traffic accidents accounted for half of the injury mechanisms. Radiographic union was reliably achieved at a mean of 10.8 ± 0.7 weeks postoperatively. Functional recovery, measured via the American Orthopaedic Foot and Ankle Society ankle-hindfoot score, showed significant continuous improvement, reaching a mean of 88.80 ± 1.51 at the 6-month mark. Concurrently, Visual Analog Scale pain scores decreased to an average of 0.60 ± 0.50. The complication profile was favorable, limited to two instances of minor implant irritation and one superficial infection.

TBW provides a biomechanically sound and highly adaptable solution for medial malleolar fractures. By facilitating stable dynamic compression, the technique yields excellent functional restoration and reliable union rates with minimal morbidity.