{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T23:49:57Z","timestamp":1791589797749,"version":"4.3.4"},"reference-count":0,"publisher":"Ovid Technologies (Wolters Kluwer Health)","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,10,9]]},"abstract":"\n Objectives:<\/jats:title>\n To compare rates of medial-sided symptomatic hardware, hardware removal, and fracture union following medial malleolus fixation using partially threaded, headless compression screws versus traditional partially threaded, headed screws.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n \n Design<\/jats:italic>\n : Retrospective cohort\n <\/jats:p>\n <\/jats:sec>\n \n Setting:<\/jats:title>\n Single, academic, Level I trauma center.<\/jats:p>\n <\/jats:sec>\n \n Patient Selection Criteria:<\/jats:title>\n Skeletally mature patients who underwent operative fixation of a medial malleolus fracture [OTA\/AO 44A-C] between 2021 and 2025 and had a minimum of 3 months follow-up were included.<\/jats:p>\n <\/jats:sec>\n \n Outcome Measures and Comparisons:<\/jats:title>\n Demographics, injury characteristics, and surgical management was collected for the headless and headed screw cohort. The primary outcome was medial-sided symptomatic hardware. Secondary outcomes included removal of hardware from the medial malleolus, medial malleolus fracture union, and infection of the medial aspect of the ankle. A comparison between the medial malleolus screw type used was undertaken.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n Of 306 patients, 195 (63.7%) received headed screws (mean age 56.0 years, range 18\u201392; 72.3% female; mean follow-up 15.1 months) and 111 (36.3%) received headless compression screws (mean age 51.0 years, range 18\u201395; 58.6% female; mean follow-up 13.2 months). Symptomatic hardware occurred in 34.8% of patients in the headed screw group compared with 20.7% in the headless screw group (p = 0.01), corresponding to an absolute risk reduction of 14.1%. Hardware removal rates did not differ between groups (30.8% vs 23.4%, p = 0.17). There were no differences in nonunion (3.6% vs 3.6%, p = 0.99) or infection rates (4.6% vs 5.4%, p = 0.97). On multivariable analysis, headless screw fixation was independently associated with a decreased likelihood of symptomatic hardware (odds ratio 0.55, 95% CI 0.32\u20130.96, p = 0.04). No independent association was observed between screw type and hardware removal.<\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n Headless compression screws may be associated with a lower rate of symptomatic hardware at a mean of one year following medial malleolus fixation without compromising fracture healing or increasing infection risk. The lower observed incidence of symptomatic implants may suggest a clinically meaningful benefit of implant selection in this subcutaneous anatomic region.<\/jats:p>\n <\/jats:sec>\n \n Level of Evidence:<\/jats:title>\n Level III, retrospective cohort study.<\/jats:p>\n <\/jats:sec>","DOI":"10.1097\/bot.0000000000003301","type":"journal-article","created":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T23:00:08Z","timestamp":1791586808000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Headless Compression Screws May Reduce Symptomatic Hardware After Medial Malleolus Fixation: A Comparative Cohort Study"],"prefix":"10.1097","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0218-5024","authenticated-orcid":false,"given":"Griffin R.","family":"Rechter","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Orlando Health Jewett Orthopedic Institute, Orlando, FL."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua R.","family":"Langford","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Orlando Health Jewett Orthopedic Institute, Orlando, FL."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. Kareem","family":"Shaath","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Orlando Health Jewett Orthopedic Institute, Orlando, FL."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy B.","family":"Baker","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Orlando Health Jewett Orthopedic Institute, Orlando, FL."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brendan E.","family":"Page","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Orlando Health Jewett Orthopedic Institute, Orlando, FL."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Yawman","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Orlando Health Jewett Orthopedic Institute, Orlando, FL."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George J.","family":"Haidukewych","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Orlando Health Jewett Orthopedic Institute, Orlando, FL."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","container-title":["Journal of Orthopaedic Trauma"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.1097\/BOT.0000000000003301","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T23:00:08Z","timestamp":1791586808000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.1097\/BOT.0000000000003301"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,9]]},"references-count":0,"URL":"https:\/\/doi.org\/10.1097\/bot.0000000000003301","relation":{},"ISSN":["0890-5339","1531-2291"],"issn-type":[{"value":"0890-5339","type":"print"},{"value":"1531-2291","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,9]]}}}