Abstract
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
Keywords
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 accessOne-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:
Subscribe to The Journal of Foot and Ankle SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Epidemiology of adult fractures: a review.Injury. 2006; 37: 691-697
- Epidemiology of fractures in the United Kingdom 1988–2012: variation with age, sex, geography, ethnicity and socioeconomic status.Bone. 2016; 87: 19-26
- Epidemiology of ankle fractures: a prospective population-based study of 212 cases in Aalborg, Denmark.Acta Orthop Scand. 1998; 69: 48-50
- The management of ankle fractures in the elderly.Injury. 2007; 38: 2-9
- 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
- First clinical results of the Locking Compression Plate (LCP).Injury. 2003; 34: B43-B54
- 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
- Locking plate technology and its use in foot and ankle surgery.Clin Podiatr Med Surg. 2011; 28: 619-631
- Fixation of osteoporotic distal fibula fractures: a biomechanical comparison of locking versus conventional plates.J Foot Ankle Surg. 2007; 46: 2-6
- 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
- Increased rates of wound complications with locking plates in distal fibular fractures.Injury. 2011; 42: 1125-1129
- A contoured locking plate for distal fibular fractures in osteoporotic bone: a biomechanical cadaver study.Injury. 2012; 43: 718-725
- 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
- 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
- Early complications of surgery in operative treatment of ankle fractures in those over 60: a review of 186 cases.Injury. 2014; 45: 780-783
- Ankle fractures in the elderly: initial and long-term outcomes.Foot Ankle Int. 2008; 29: 1184-1188
- 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
- Increased rates of wound complications with locking plates in distal fibular fractures.Injury. 2011; 42: 1125-1129
- Locking versus non-locking neutralization plates for treatment of lateral malleolar fractures: a randomized controlled trial.Int Orthop. 2013; 37: 2451-2456
- Cost description of inpatient treatment for ankle fracture.Injury. 2011; 42: 1226-1229
- Comparison of three plate system for lateral malleolar fixation.BMC Musculoskelet Disord. 2014; 15: 360
- 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
Article info
Publication history
Published online: April 19, 2018
Footnotes
Financial Disclosure: None reported.
Conflict of Interest: None reported.
Identification
Copyright
Crown Copyright © 2017. Published by Elsevier Inc. on behalf of the American College of Foot and Ankle Surgeons. All rights reserved.
