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Войти в исследования Journal of orthopaedic trauma · 2026
Headless Compression Screws May Reduce Symptomatic Hardware After Medial Malleolus Fixation: A Comparative Cohort Study.
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Rechter Griffin R, Langford Joshua R, Shaath M Kareem, Baker Timothy B, Page Brendan E, Yawman Jonathan, Haidukewych George J
Аннотация
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.
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.