Cannulated screws versus plates for posterior malleolar fractures: a retrospective comparative study with a minimum 3-year follow-up

Abstract Background Currently, there is no clear consensus in the literature regarding the optimal method of fixation for posterior malleolus fractures (PMFs). This study aims to compare a minimum 3-year follow-up clinical outcomes of cannulated screws versus plates fixation for these fractures. Methods A retrospective study was conducted on patients with PMFs who underwent treatment with cannulated screws or plates between January 2015 and November 2021. Comparisons were conducted between the groups regarding operative time, blood loss, time to weight-bearing, the Olerud-Molander Ankle Score (OMAS), the Visual Analog Scale (VAS), and dorsiflexion deficit (DFD), early(infection, sural nerve injury) and late (hallux contracture, traumatic arthritis) postoperative complications. Results The average follow-up time for all patients was 78.9 months (range 41-125 months). A total of 75 patients were included (47 screws and 28 plates). No statistically significant differences in incision infection, sural nerve injury,traumatic arthritis, incidence of hallux contracture, OMAS, VAS , DFD between the two groups (P > 0.05). Compared with the plate group, the cannulated screw group exhibited shorter operative time, less blood loss (P < 0.05). However, the plate group had a shorter time to weight-bearing. Conclusions Both techniques employed in the treatment of posterior ankle fractures have yielded favorable outcomes. The screw group experienced shorter operative time, marginally less blood loss. Conversely, the plate group achieved earlier weight-bearing times, which may be attributed to its biomechanical characteristics and the surgeon’s confidence. Level of clinical evidence 3