{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,24]],"date-time":"2025-08-24T07:40:02Z","timestamp":1756021202788,"version":"3.44.0"},"reference-count":29,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2025,8,20]],"date-time":"2025-08-20T00:00:00Z","timestamp":1755648000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Foot &amp; Ankle Specialist"],"abstract":"<jats:p>Purpose. This study aimed to evaluate the stability of bimalleolar ankle fracture fixation techniques (bicortical and unicortical lag screw) in simulated progressive rehabilitation with a walking boot. Methods. Five matched pairs of lower extremities underwent simulated bimalleolar ankle fracture and were randomly assigned into these 2 repair groups. Each specimen was tested under an axial compression cyclic load test for 10000 cycles at a rate of 1 Hz while the ankle was held in 30\u00b0 inclination. Radiographic assessments (screw attached lengths [length from screw head to far cortex], fracture gap, and joint clear space [medial, superior, and lateral]) by 3 examiners were performed at 0th, 5000th, and 10000th cycles. Three repeated measurements by each examiner. Results. The overall level of intra-rater reliability for all 3 raters and all measurements were found to be within \u201cmoderate\u201d to \u201cexcellent\u201d agreement. For radiographic screw loosening and fracture displacement, evaluation found that at no time point did either the bicortical group or the unicortical group meet the minimal threshold of clinical failure which defined as 2-mm of screw displacement or 2-mm of fracture displacement. Conclusion. Both bicortical and traditional unicortical lag screw fixation techniques provide equivalent stability for medial malleolar fractures in a bimalleolar ankle fracture during simulated progressive rehabilitation with a walking boot. This could potentially have clinical benefits in patient care with earlier return to function, prevention of stiffness and loss of range of motion, and decreased muscle atrophy during the postoperative rehabilitation period.<\/jats:p>\n          <jats:p>\n            <jats:bold>Level of Evidence<\/jats:bold>\n            : Level V: bench top testing\n          <\/jats:p>","DOI":"10.1177\/19386400251363023","type":"journal-article","created":{"date-parts":[[2025,8,20]],"date-time":"2025-08-20T11:00:01Z","timestamp":1755687601000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Biomechanical Evaluation of Bicortical Versus Unicortical Lag Screw Bimalleolar Ankle Fracture Fixation Techniques With Simulated Walking Boot"],"prefix":"10.1177","author":[{"given":"Travis R.","family":"Flick","sequence":"first","affiliation":[{"name":"Department of Sanford Medical Education, Sanford Health, Fargo, ND"},{"name":"School of Medicine &amp; Health Sciences, University of North Dakota, Grand Forks, ND"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4552-8314","authenticated-orcid":false,"given":"Alexander CM.","family":"Chong","sequence":"additional","affiliation":[{"name":"Department of Sanford Medical Education, Sanford Health, Fargo, ND"},{"name":"School of Medicine &amp; Health Sciences, University of North Dakota, Grand Forks, ND"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jordan D.","family":"Shearer","sequence":"additional","affiliation":[{"name":"Department of Sanford Medical Education, Sanford Health, Fargo, ND"},{"name":"School of Medicine &amp; Health Sciences, University of North Dakota, Grand Forks, ND"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anthony N.","family":"Brown","sequence":"additional","affiliation":[{"name":"Department of Sanford Medical Education, Sanford Health, Fargo, ND"},{"name":"School of Medicine &amp; Health Sciences, University of North Dakota, Grand Forks, ND"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,8,20]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-198062080-00002"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-197658030-00010"},{"key":"e_1_3_3_4_2","unstructured":"Barbosa P Bonnaire F Kojima K. AO foundation medial transverse fracture: lag screws; 2024. https:\/\/surgeryreference.aofoundation.org\/orthopedic-trauma\/adult-trauma\/malleoli\/basic-technique\/medial-transverse-fracture-lag-screws. Accessed September 25 2024."},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620x.101B5.BJJ-2019-0070"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/BOT.0b013e3182404512"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.jfas.2010.02.006"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1097\/BOT.0000000000000572"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1097\/BOT.0b013e318214bf1b"},{"issue":"3","key":"e_1_3_3_10_2","first-page":"360","article-title":"Immediate unprotected weight-bearing of operatively treated ankle fractures","volume":"73","author":"Gul A","year":"2007","unstructured":"Gul A, Batra S, Mehmood S, Gillham N. Immediate unprotected weight-bearing of operatively treated ankle fractures. Acta Orthop Belg. 2007;73(3):360-365.","journal-title":"Acta Orthop Belg"},{"issue":"302","key":"e_1_3_3_11_2","first-page":"273","article-title":"Experimental study of the effect of weight bearing on fracture healing in the canine tibia","volume":"1994","author":"O\u2019Sullivan ME","unstructured":"O\u2019Sullivan ME, Bronk JT, Chao EY, Kelly PJ. Experimental study of the effect of weight bearing on fracture healing in the canine tibia. 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