Clinical Outcomes of Fibula Fractures Fixed With Clamp Compression and Positional Screws Versus Lag Screws—Is There a Difference?

Introduction: Although lag screws (LSs) provide increased compression, they are not always clinically feasible (eg, bone quality, fracture configuration) and have not been shown to be clinically superior to clamp compression and positional screw (PS) fixation. The purpose of this study is to compare clinical outcomes of fibular fractures between the two screw techniques. Methods: Consecutive patients of >18 years of age, between 2015 and 2020, were identified based on current procedural terminology codes for surgical fibula fixation. Patients with fibular fractures fixed with an interfragmentary screw and with a minimum of 6 months of follow-up were included in the study. This patient cohort was divided into two groups: LS and PS Results: A total of 189 patients were included. Average age was 45 years with 51% female. Forty had distal fibula fractures only, 69 had bimalleolar, and 80 had trimalleolar fractures; 66 (37.5%) had syndesmotic injuries. Eighty-four fibula fractures were fixed with clamp compression and PS, and 105 with a LS. Groups were similar with regard to age, sex, diabetes, and smoking. Union rate in both groups was 100%. Revision surgery rate was higher in the LS group (10.5% vs. 3.6%, P = 0.072). Conclusion: Our study indicates noninferiority of interfragmentary PS technique (clamp compression and PS use) for lateral malleolus fractures with high rates of union and low rates of revision surgery. Level of Evidence: Therapeutic Level III