A wonderful CC image by Theen Moy

In my last post I talked about the posterior malleolus, and I figured it would be natural to follow up with the medial malleolus. In an RCT by Hoelsbrekken et al., the authors followed 100 patients for three years and found no difference between those treated operatively and non-operatively.

Worth noting is that they included only fractures with <2 mm displacement. Their fixation method used two 3.5 mm lag screws, which carries a risk of interfering with the tibialis posterior tendon.

More recently, Buckley et al. showed that a single screw provides adequate fixation, with identical outcomes at two years and no difference even at the three-month follow-up. That said, in osteoporotic bone there are indications that two screws may provide better stability.