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Background: Fractures of the medial malleolus are part of the ankle injures which require an orthopedic care. Most of these injuries are low energy, rotational injuries. Many modalities of treatment are present, including non-operative or operative treatment to restore normal anatomical alignment and to resume normal fictional ability of the ankle. Aim of study: To determine the outcome of surgical treatment of the medial malleolar fractures by tension band wiring versus screws fixation techniques. Patients and Methods: Randomized controlled trial conducted to study two groups of patients at Department of Orthopedic surgery in Al- Hussain medical city teaching hospital from July 2017 to July 2020, to evaluate the outcome of 36 patients with closed displaced horizontal oblique medial malleolar fractures. All the patients admitted to the emergency department of the hospital and operated within 24 hours. The study is based on 36 patients including males and females having closed displaced medial malleolar fractures of skeletally mature patients, divided in to two groups; group (A) managed by tension band wiring and group (B) with screws fixation, and followed for a maximum period of 20 weeks looking for union rate, infection, loss of reduction and the reoperation rate. Results: Out of the (36) patients, follow up was missed in 2 patients, the other (34) patients were divided in to two groups (AB The union rate was (87.5%) within 12 weeks, delayed union (union achieved after 12 weeks and before 20 weeks) in 2 patients (12.5%), no cases of non- union, infection reported in one patient (6.2%), no case with reoperation had been reported. In groups B (18 patients with scores fixation), the union rate was (77.8%) within 12 weeks, delayed union in 4 patients (22.2%), no cases of nonunion, infection reported in one patient (5.6%), and reoperation in two parents (11.1%) had been reported. Conclusion: From this study, we concluded that the results of both groups were good regarding the union rates, low risk of infection, and low reparation rate in screws fixation groups. The tension band wiring technique seems to be more rigid as a fixation technique with no reoperation rate.

Screw fixation versus tension band wiring in Treatment of closed displaced horizontal oblique medial malleolar fracture