Headless Compression Screws May Reduce Symptomatic Hardware After Medial Malleolus Fixation: A Comparative Cohort Study.

IF 2 3区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Trauma Pub Date : 2026-10-09 DOI:10.1097/BOT.0000000000003301

Griffin R Rechter, Joshua R Langford, M Kareem Shaath, Timothy B Baker, Brendan E Page, Jonathan Yawman, George J Haidukewych

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引用次数: 0

Abstract

Objectives: To compare rates of medial-sided symptomatic hardware, hardware removal, and fracture union following medial malleolus fixation using partially threaded, headless compression screws versus traditional partially threaded, headed screws.

Methods: Design: Retrospective cohort.

Setting: Single, academic, Level I trauma center.

Patient selection criteria: Skeletally mature patients who underwent operative fixation of a medial malleolus fracture [OTA/AO 44A-C] between 2021 and 2025 and had a minimum of 3 months follow-up were included.

Outcome measures and comparisons: Demographics, injury characteristics, and surgical management was collected for the headless and headed screw cohort. The primary outcome was medial-sided symptomatic hardware. Secondary outcomes included removal of hardware from the medial malleolus, medial malleolus fracture union, and infection of the medial aspect of the ankle. A comparison between the medial malleolus screw type used was undertaken.

Results: Of 306 patients, 195 (63.7%) received headed screws (mean age 56.0 years, range 18-92; 72.3% female; mean follow-up 15.1 months) and 111 (36.3%) received headless compression screws (mean age 51.0 years, range 18-95; 58.6% female; mean follow-up 13.2 months). Symptomatic hardware occurred in 34.8% of patients in the headed screw group compared with 20.7% in the headless screw group (p = 0.01), corresponding to an absolute risk reduction of 14.1%. Hardware removal rates did not differ between groups (30.8% vs 23.4%, p = 0.17). There were no differences in nonunion (3.6% vs 3.6%, p = 0.99) or infection rates (4.6% vs 5.4%, p = 0.97). On multivariable analysis, headless screw fixation was independently associated with a decreased likelihood of symptomatic hardware (odds ratio 0.55, 95% CI 0.32-0.96, p = 0.04). No independent association was observed between screw type and hardware removal.

Conclusions: Headless compression screws may be associated with a lower rate of symptomatic hardware at a mean of one year following medial malleolus fixation without compromising fracture healing or increasing infection risk. The lower observed incidence of symptomatic implants may suggest a clinically meaningful benefit of implant selection in this subcutaneous anatomic region.

Level of evidence: Level III, retrospective cohort study.

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无头加压螺钉可减少内踝固定后出现的症状：一项比较队列研究。

目的：比较使用部分有螺纹无头加压螺钉与传统部分有螺纹有头螺钉内固定内踝后内侧侧有症状的内固定物、内固定物取出和骨折愈合的比率。方法：设计：回顾性队列。环境：单人，学术，一级创伤中心。患者选择标准：纳入2021 - 2025年间接受内踝骨折手术固定的骨骼成熟患者[OTA/AO 44A-C]，随访时间至少为3个月。结果测量和比较：收集了无头螺钉组和有头螺钉组的人口统计学、损伤特征和手术处理。主要结局是中侧症状硬体。次要结果包括内踝内固定物取出、内踝骨折愈合和踝关节内侧感染。对内踝螺钉类型进行了比较。结果：306例患者中，195例（63.7%）接受有头螺钉治疗（平均年龄56.0岁，范围18-92岁；女性72.3%，平均随访15.1个月）；111例（36.3%）接受无头加压螺钉治疗（平均年龄51.0岁，范围18-95岁；女性58.6%，平均随访13.2个月）。有头螺钉组出现症状性内固定的比例为34.8%，无头螺钉组为20.7% (p = 0.01)，绝对风险降低14.1%。各组间硬体移除率无差异（30.8% vs 23.4%, p = 0.17）。不愈合（3.6% vs 3.6%, p = 0.99）或感染率（4.6% vs 5.4%, p = 0.97）无差异。在多变量分析中，无头螺钉固定与症状性内固定的可能性降低独立相关（优势比0.55,95% CI 0.32-0.96, p = 0.04）。螺钉类型和内固定去除之间没有独立的关联。结论：在内踝固定后平均一年内，无头加压螺钉可能与较低的症状性内固定率相关，而不会影响骨折愈合或增加感染风险。观察到的较低的症状性植入发生率可能表明在这个皮下解剖区域选择植入物具有临床意义。证据等级：III级，回顾性队列研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Orthopaedic Trauma 医学-运动科学

CiteScore

3.90

自引率

8.70%

发文量

396

审稿时长

3-8 weeks

期刊介绍： Journal of Orthopaedic Trauma is devoted exclusively to the diagnosis and management of hard and soft tissue trauma, including injuries to bone, muscle, ligament, and tendons, as well as spinal cord injuries. Under the guidance of a distinguished international board of editors, the journal provides the most current information on diagnostic techniques, new and improved surgical instruments and procedures, surgical implants and prosthetic devices, bioplastics and biometals; and physical therapy and rehabilitation.