Research Article| Volume 57, ISSUE 4, P664-667, July 2018

Download started.


Comparison of Locking Versus Nonlocking Plates for Distal Fibula Fractures

Published:April 19, 2018DOI:


      Locking plates might offer a biomechanical fixation advantage for distal fibula fractures with comminution or osteoporotic bone. In January 2011, our unit introduced a bone-specific locking plate for the distal fibula. The aim of the present study was to compare it against more conventional plating system implants for lateral malleolar fixation in terms of outcomes, crude costs, and complications. We retrospectively reviewed a consecutive cohort of patients with closed ankle fractures who presented within a 24-month period. The clinical and radiographic outcomes were compared among conventional plating using a one-third semitubular plate, a 3.5-mm limited-contact dynamic compression plate, and a 2.7-mm/3.5-mm locking compression distal fibula plate. A total of 145 patients with ankle fractures underwent surgical fixation: 87 (60.0%) with the semitubular plate, 22 (15.2%) with the limited-contact dynamic compression plate, and 36 (24.8%) with the locking compression distal fibula plate. A greater proportion of patients with established osteoporosis or osteoporosis risk factors were in the locking compression distal fibula plate group (27.8% versus 2.3% and 0%). Four patients (2.8%) required washout for infection. No significant differences were found between the sex distribution within the 3 groups (p = .432). No significant difference was found in the complication rate (p = .914) or the reoperation rate (p = .291) among the 3 groups. Although costing >6 times more than a standard fibula fixation construct (implant cost), bone-specific locking compression distal fibula plates add to the portfolio of implants available, especially for unstable fractures with poor bone quality.

      Level of Clinical Evidence


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The Journal of Foot and Ankle Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Court-Brown C.M.
        • Caesar B.
        Epidemiology of adult fractures: a review.
        Injury. 2006; 37: 691-697
        • Curtis E.M.
        • van der Velde R.
        • Moon R.J.
        • van den Bergh J.P.
        • Geusens P.
        • de Vries F.
        • van Staa T.P.
        • Cooper C.
        • Harvey N.C.
        Epidemiology of fractures in the United Kingdom 1988–2012: variation with age, sex, geography, ethnicity and socioeconomic status.
        Bone. 2016; 87: 19-26
        • Jensen S.L.
        • Andresen B.K.
        • Mencke S.
        • Nielsen P.T.
        Epidemiology of ankle fractures: a prospective population-based study of 212 cases in Aalborg, Denmark.
        Acta Orthop Scand. 1998; 69: 48-50
        • Strauss E.J.
        • Egol K.A.
        The management of ankle fractures in the elderly.
        Injury. 2007; 38: 2-9
        • Zahn R.K.
        • Jakubietz M.
        • Frey S.
        • Doht S.
        • Sauer A.
        • Meffert R.H.
        A locking contoured plate for distal fibular fractures: mechanical evaluation in an osteoporotic bone model using screws of different length.
        J Appl Biomech. 2014; 30: 50-57
        • Sommer C.
        • Gautier E.
        • Müller M.
        • Helfet D.L.
        • Wagner M.
        First clinical results of the Locking Compression Plate (LCP).
        Injury. 2003; 34: B43-B54
        • Perren S.M.
        Evolution of the internal fixation of long bone fractures. The scientific basis of biological internal fixation: choosing a new balance between stability and biology.
        J Bone Joint Surg Br. 2002; 84: 1093-1110
        • Dial D.M.
        • Ryan M.
        Locking plate technology and its use in foot and ankle surgery.
        Clin Podiatr Med Surg. 2011; 28: 619-631
        • Kim T.
        • Ayturk U.M.
        • Haskell A.
        • Miclau T.
        • Puttlitz C.M.
        Fixation of osteoporotic distal fibula fractures: a biomechanical comparison of locking versus conventional plates.
        J Foot Ankle Surg. 2007; 46: 2-6
        • Winkler B.
        • Weber B.G.
        • Simpson L.A.
        The dorsal antiglide plate in the treatment of Danis-Weber type-B fractures of the distal fibula.
        Clin Orthop Relat Res. 1990; 259: 204-209
        • Schepers T.
        • Van Lieshout E.M.
        • De Vries M.R.
        • Van der Elst M.
        Increased rates of wound complications with locking plates in distal fibular fractures.
        Injury. 2011; 42: 1125-1129
        • Zahn R.K.
        • Frey S.
        • Jakubietz R.G.
        • Jakubietz M.G.
        • Doht S.
        • Schneider P.
        • Waschke J.
        • Meffert R.H.
        A contoured locking plate for distal fibular fractures in osteoporotic bone: a biomechanical cadaver study.
        Injury. 2012; 43: 718-725
        • Nguyentat A.
        • Camisa W.
        • Patel S.
        • Lagaay P.
        A biomechanical comparison of locking versus conventional plate fixation for distal fibula fractures in trimalleolar ankle injuries.
        J Foot Ankle Surg. 2016; 55: 132-135
        • Takemoto R.C.
        • Sugi M.T.
        • Kummer F.
        • Koval K.J.
        • Egol K.A.
        The effects of locked and unlocked neutralization plates on load bearing of fractures fixed with a lag screw.
        J Orthop Trauma. 2015; 26: 519-522
        • Zaghloul A.
        • Haddad B.
        • Barksfield R.
        • Davis B.
        Early complications of surgery in operative treatment of ankle fractures in those over 60: a review of 186 cases.
        Injury. 2014; 45: 780-783
        • Anderson S.A.
        • Li X.
        • Franklin P.
        • Wixted J.J.
        Ankle fractures in the elderly: initial and long-term outcomes.
        Foot Ankle Int. 2008; 29: 1184-1188
        • Naumann M.G.
        • Sigurdsen U.
        • Utvåg S.E.
        • Stavem K.
        Incidence and risk factors for removal of an internal fixation following surgery for ankle fracture: a retrospective cohort study of 997 patients.
        Injury. 2016; 47: 1783-1788
        • Schepers T.
        • Van Lieshout E.M.M.
        • De Vries M.R.
        • Van Der Elst M.
        Increased rates of wound complications with locking plates in distal fibular fractures.
        Injury. 2011; 42: 1125-1129
        • Tsukada S.
        • Otsuji M.
        • Shiozaki A.
        • Yamamoto A.
        • Komatsu S.
        • Yoshimura H.
        • Ikeda H.
        • Hoshino A.
        Locking versus non-locking neutralization plates for treatment of lateral malleolar fractures: a randomized controlled trial.
        Int Orthop. 2013; 37: 2451-2456
        • Murray A.M.
        • McDonald S.E.
        • Archbold P.
        • Crealey G.E.
        Cost description of inpatient treatment for ankle fracture.
        Injury. 2011; 42: 1226-1229
        • Huang Z.
        • Liu L.
        • Tu C.
        • Zhang H.
        • Fang Y.
        • Yang T.
        • Pei F.
        Comparison of three plate system for lateral malleolar fixation.
        BMC Musculoskelet Disord. 2014; 15: 360
        • Kim H.J.
        • Oh J.K.
        • Hwang J.H.
        • Park Y.H.
        The use of T-LCP (locking compression plate) for the treatment of the lateral malleolar fractures.
        Eur J Orthop Surg Traumatol. 2013; 23: 233-237