Medial malleolus screws: out in one view and out
Cartilage damage or mechanical blocking from screw penetration into intra-articular cartilage can reduce the chances of successful outcomes during medial malleolus fixation. There have been diverging opinions among surgeons concerning the reliability of radiographic assessment of fracture fixation and malleolus screw positioning. Therefore, this radiographic study examines the location of medial malleolus lag screws relative to the ankle mortise articular surface. In three Sawbones models, Kirschner wires were overdrilled with a 4.0-mm cannulated cortical screw simulating screws that would be intra- and extra-articular when performing open reduction and internal fixation of a medial malleolar fracture. Under fluoroscopy, images were evaluated to determine whether known intra-articular screws appeared extra-articular in any radiographic view. No image from models with known intra-articular penetration appeared extra-articular in any view or under “live” fluoroscopy. At 20° internal rotation, a screw with a known extra-articular position appeared to be within the cartilage. Intra-operative fluoroscopy is necessary to ensure proper extra-articular placement of screws. If a screw is pictured extra-articular in any radiograph, then it can be assumed that the screw is indeed out of the joint.
KeywordsMedial malleolus Ankle radiography Fracture Internal fixation
Compliance with ethical standards
Conflict of interest
Dr. Wera has nothing to disclose. Dr. Seligson reports Grants from Fischer-Owen Orthopaedic Trust fund, during the conduct of the study; personal fees from University of Louisville Department of Orthopaedic Surgery, personal fees from Stryker, personal fees from Books, outside the submitted work. Dr. Riehl has nothing to disclose.
This article does not contain any studies with human participants or animals performed by any of the authors.
- 3.Pankovich AM (1991) Trauma to the ankle. In: Jahss MH (ed) Disorders of the foot and ankle: medical and surgical management, 2nd edn. W.B Saunders, Philadelphia, pp 2361–2414Google Scholar
- 4.Shelton ML (1994) Complications of fractures and dislocations of the ankle. In: Epps CH Jr (ed) Complications in orthopaedic surgery, vol 2, 3rd edn. J.B Lippincott, Philadelphia, pp 595–648Google Scholar
- 6.Geissler WB, Tsao AK, Hughes JL (1996) Fractures and injuries of the ankle. Rockwood and green’s fractures in adults, 4th edn. Lippincott-Raven, Philadelphia, pp 2201–2261Google Scholar
- 19.Kang K, Chen Y, Qiang M, Hao Y, Li H, Dai H (2014) The morphology of medial malleolus and its clinical relevance. Pak J Med Sci 30:348–351Google Scholar