Comparative Outcomes of Fully Threaded Headless Compression Screws and Partially Threaded Screws in Medial Malleolus Fracture Fixation: A Systematic Review and Meta-Analysis. [Review]

Hamsho, W.; Raufi, MY.; Elgendy, M.; Elrouby, M.; Alnajjar, M.

Comparative Outcomes of Fully Threaded Headless Compression Screws and Partially Threaded Screws in Medial Malleolus Fracture Fixation: A Systematic Review and Meta-Analysis. [Review]

All Authors

Hamsho, W.

Raufi, MY.

Elgendy, M.

Elrouby, M.

Alnajjar, M.

LTHT Author

Hamsho, Ward
Elrouby, Mohamed
Alnajjar, Mohammad

LTHT Department

Trauma & Related Services
Orthopaedics

Publication Date

2026

Item Type

Journal Article
Review

Subject

ANKLE INJURIES , FOOT INJURIES , HOSPITALISATION , ORTHOPAEDIC FIXATION DEVICES

Abstract

Medial malleo lus fractures ar e com mon injuries, and screw fixation i s the standard treatment. The c hoice bet ween fully t hreaded headless compression screws (FTHCSs) and partially thr eaded screws (PTSs) remains co ntroversial, particula rly regar ding soft-tis sue irritation and reop eration rates. This syst ematic review and meta-analysis aimed to compare the cli ni ca l and f unctio nal outcomes of FTHC Ss versus PTS s for medial malleolus fracture fixat ion . This re view was con duct ed according to the PROSPERO protocol (Registrati o n ID: CRD420251170989) a nd Pr eferred Report ing Items for Systematic Reviews an d Meta-Analyses (PRISMA) guidelines. A systematic s earch identified comparative studies e valuating F THCSs a ga inst PTSs for medial malleolus f ractu re s. Data, including func tional scores of the American Orthopaedic Foot and Ankle Society (AOFAS), symptomatic hardware and implant removal, were pooled using a random-effects model . Dichotomous data were analyzed using risk ratios (RR s), and continuous data using mean differences (MDs), with 95% co nfide nce intervals (CIs). Het ero geneity was assesse d using the I2 statistic. Risk of bias was as sessed using the MINORS tool. Three retrospe ctive c omparative studies , i ncluding 146 patients (72 FTHCSs, 74 PTSs), we re i ncluded. The p oo led anal ysis showed a borderline statistically significant tre n d favouring FTHCSs for function al outcome (AOFAS score: MD = 1.64, 95% CI: -0. 01, 3. 2 8; P=0.05). However, FTHCS s significantly reduce d the risk of symptoma tic h ardware (RR = 0.1 7, 95 % CI: 0.08, 0.38; P < 0.0001) a nd the ri sk of implan t r emoval (RR = 0.10, 95% CI: 0.02, 0. 51; P = 0.006). All studies reported a 100% union rate in both groups. Two studies re port ed significantl y lower post- opera tive pa in (VAS) in the FTH CS group. Heterogeneity was low for all pooled out comes (I2= 0%). FTHC S f ixation for medial m a lleolus fra ctures is a ssociated with a significa ntly lower risk of sympto matic hardware and sub sequent implant removal co mpared to PTSs, with comparable union rate s and functional ou tc omes. Given t he high rate of second ary pr ocedures associated w ith PTSs, FTHCSs may be the preferre d implant for medial mal leolus fixa tion. T he overall qual ity of evidence is low due to the i nclusion o f only retrospec tive studies.