Medial malleolar fractures: hook plates versus lag screws fixation. A prospective multicenter observational study
Abstract
Objective. This prospective multicenter observational study compares clinical, functional, and radiological outcomes of hook plate versus lag screw fixation for medial malleolar fractures.
Methods. Between June 1, 2019, and June 1, 2021, a prospective observational study was conducted across 5 hospitals. Sixty-one patients with isolated medial malleolar fractures or bimalleolar fractures were enrolled and assigned to two groups based on the treatment received: lag screw fixation (n = 30) or hook plate fixation (n = 31). Outcomes included AOFAS, OMAS, VAS scores and radiographic evaluations.
Results. Hook plate fixation yielded higher AOFAS (90.2 ± 9.7 vs 74.3 ± 13.8; p = 0.001), OMAS (85.7 ± 9.5 vs 71.0 ± 13.6; p = 0.002), healing rate (100% vs 86.6%; p = 0.050), and shorter time to union (9.7 vs 13.3 weeks; p = 0.044).
Conclusion. Hook plate fixation provides superior functional outcomes and higher healing rates compared to lag screws, particularly in osteoporotic or comminuted fractures. Careful patient selection and surgical technique are essential.
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© © Ortopedici Traumatologi Ospedalieri d’Italia (O.T.O.D.i.) , 2026
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