Lag screw only fixation of the lateral malleolus

Objectives: To evaluate the use of lag screw only fixation of noncomminuted oblique fractures of the lateral malleolus in patients younger than fifty years of age. Design: Prospective evaluation Setting: Level I trauma center. Patients and Participants: Forty-seven ankle fractures with simple oblique patterns and no comminution that were long enough to accept two lag screws placed at least 1 centimeter apart were prospectively evaluated. All patien ts were younger than fifty years of age. There were twenty-three Ligamentou s SE4, eighteen bimalleolar SE4, and six PE4 fractures. Intervention: Open reduction and internal fixation with lag screw only fixa tion of the lateral malleolus. Main Outcome Measurements: Radiographic and clinical outcome parameters wer e compared with those of a cohort of patients previously treated at the sam e institutions using different techniques. Results: Thirty-five patients' ankles were fixed with two lag screws, ten w ith three lag screws, and two with four lag screws. The incision for lag sc rew placement was 30 percent shorter and slightly more anterior than that i n the comparison group. No patient lost reduction and there were no soft-ti ssue complications in the group. Follow up averaged 1.6 years for forty-two patients. One patient (2 percent) had complaints of lateral pain in the st udy, compared with 17 percent in the plate group. No patient fixed with lag screws had palpable hardware, as compared with 56 percent in the plate gro up. None had any restrictions in shoe wear, as compared with 15 percent in the plate group. No patient required screw removal, as compared with 31 per cent in the plate group. There was no difference in radiographic outcome be tween the two groups. Conclusions: Lag screw only fixation is a useful and successful method for appropriately selected lateral malleolar fractures.