Lag screw only fixation for lateral malleolar fractures: a systematic review and meta-analysis

Ankle fractures are common injuries, most typically involving the distal fibula and often requiring surgery. Traditional surgical techniques often utilise an interfragmentary compression screw (lag screw) and a neutralisation fibular plate. Due to limited subcutaneous tissue, such plates can be prominent, leading to wound complications, infections, and ankle pain. The lag screw-only (LSO) fixation has been suggested to provide adequate fixation and healing while minimizing soft tissue complications and reoperation rates.

To undertake a systematic review and meta-analysis of the current evidence for utility of LSO fixation of the lateral malleolar fractures.

A systematic review of the literature was conducted for all comparative clinical papers examining LSO fixation on Pubmed and Embase. No timeframe restriction was used. Non-clinical papers and supplementation other than LSO fixation were excluded. Papers were then analysed for rates of union, post operative wound complications and rates of reoperation.

3 papers were found with a total of 227 patients. 104 had LSO fixation, the remaining 123 patients were matched control groups with similar fracture morphology and treated with a fibular plate. Meta-analysis revealed statistically significantly lower rates of reoperation in the LSO group with no difference in rate of union between groups.

LSO fixation may be a beneficial method of fixation for selected patients and fracture patterns in ankle fractures. The current evidence suggests similar rates of union when compared to traditional fibular plating with lower risks of reoperation.