Tension band wiring versus screw fixation for the treatment of medial malleolar fractures: A systematic review and meta-analysis

Introduction: Tension band wiring (TBW) and screw fixation (SF) are common surgical treatments for medial malleolar fractures (MMFs); however, no systematic review has identified which fixation method is superior. This study aimed to determine the most optimal MMF fixation method by comparing the clinical and radiological outcomes of TBW and SF through a systematic review and meta-analysis of the literature.Hypothesis: We hypothesized that there may be differences in outcomes between TBW and SF for treating MMFs.Methods: MEDLINE, Embase, and the Cochrane Library were systematically searched for studies that compared TBW and SF for MMF treatment published through June 8, 2021. Fracture union, outcome scores, and postoperative complications were analyzed. Results: We included 10 studies with 512 MMF cases; 218 and 294 patients were treated with TBW and SF, respectively. Pooled analysis revealed no significant differences between them for all outcome variables, including the time to fracture union (mean difference = -0.59 weeks; 95% confidence interval [CI], -1.82 to 0.64; p = 0.35; I2 = 70%), number of excellent or good outcomes based on the final Olerud and Molander Ankle score (odds ratio [OR], 1.46; 95% CI, 0.53-5.02; p = 0.47; I2 = 0%), delayed union rate (OR, 0.94; 95% CI, 0.34-2.59; p = 0.91; I2 = 17%), superficial infection rate (OR, 1.19; 95% CI, 0.33-4.26; p = 0.79; I2 = 0%), and number of fixation failures (OR, 0.53; 95% CI, 0.16-1.74; p = 0.29; I2 = 13%).Conclusions: Both TBW and SF are excellent clinical and radiological methods for MMF fixation. However, an appropriate fixation method should be chosen according to the fracture type and size and bone quality considering the advantages and disadvantages of each method. Level of evidence: III, meta-analysis.& COPY; 2022 Elsevier Masson SAS. All rights reserved.