Multifragmentary Medial Malleolus Fixation in Trimalleolar Ankle Fractures: A Comparison of Cannulated Screw and Tension Band Wiring Techniques

Objective: To compare the 12-month clinical outcomes of cannulated compression screw (CCS) and tension band wiring (TBW) fixation of the multifragmentary medial malleolus component in trimalleolar ankle fractures.Material and Methods: This retrospective cohort study evaluated consecutive adult patients who underwent surgery for trimalleolar ankle fractures with a multifragmentary medial malleolus component at a single Level I trauma center between 2019 and 2025. After application of the exclusion criteria, 63 patients were included in the CCS (n = 33) and TBW (n = 30) groups. Clinical outcomes were assessed at 12 months using the Visual Analogue Scale (VAS), American Orthopedic Foot and Ankle Society (AOFAS) score, and Olerud–Molander Ankle Score (OMAS).Results: Groups were comparable for age and fracture side (p = .103 and p = .078, respectively). The OMAS was significantly higher in the CCS group (p = .022), and this association persisted after adjustment for measured confounders (adjusted mean difference 5.14 OMAS points; 95% CI [1.76, 8.52]); however, the difference remained below the minimal clinically important difference (MCID) threshold and may reflect residual confounding. VAS and AOFAS scores did not differ significantly between the groups (p = .088 and p = .756, respectively).Conclusion: In multifragmentary medial malleolus fractures within trimalleolar injuries, both fixation techniques provided satisfactory ankle function at one year. Neither was clearly superior: the small OMAS difference in favor of cannulated screw fixation fell below the threshold for clinical importance and may reflect residual confounding. Technique selection should therefore remain individualized, and adequately powered prospective studies are needed to establish whether either implant offers a clinically meaningful benefit.