Comparison of different locking plate fixation methods in lateral malleolus fractures

Bilgetekin, Yenel Gürkan; Çatma, Mehmet Faruk; Öztürk, Alper; Ünlü, Serhan; Ersan, Önder

doi:10.1016/j.fas.2018.01.004

Cited by 20 publications

(24 citation statements)

References 27 publications

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“…Eleven studies were considered suitable for inclusion in this systematic review and meta-analysis. 4,7,8,11,12,17,20,21,25,26,28 Ten of the included studies were retrospective cohort studies. 4,7,8,11,12,17,20,21,25,26 One of the included studies was a randomized controlled trial.…”

Section: Searchmentioning

confidence: 99%

“…4,7,8,11,12,17,20,21,25,26,28 Ten of the included studies were retrospective cohort studies. 4,7,8,11,12,17,20,21,25,26 One of the included studies was a randomized controlled trial. 28…”

Section: Searchmentioning

confidence: 99%

“…4,11,12,26 Different functional outcome measure tools were used: Shih et al 26 used the Foot and Ankle Outcome Score (FAOS), Bilgetekin et al 4 and Herrera-Pérez et al 11 used the American Orthopaedic Foot & Ankle Society (AOFAS) score), and Huang et al 12 used both the Olerud Molander Score (OMS) and the AOFAS score. The follow-up time at which the AOFAS score had been measured was not reported by Bilgetekin et al 4 All other studies reported results on the long term (ie, after 6 months), Herrera-Pérez et al 11 was the only study that reported both short-term (ie, less than 6 months) and longterm scores (Table 2). Huang et al 12 compared and analyzed functional outcome scores for 3 groups (nonlocking, nonanatomical locking, and anatomical locking).…”

Section: Functional Outcomementioning

confidence: 99%

“…13 In the last decade, the increasing amount of literature on the use of locking plates in ankle fracture surgery suggests an increasing use of this type of plate osteosynthesis in daily practice. 1,2,4,7,8,11,12,17,20,21,23,25,26,28 Plate osteosynthesis can be carried out using conventional nonlocking plates, such as one-third tubular plates or dynamic compression plates, but plate osteosynthesis can also be carried out with a variety of later developed locking plates, such as locking compression plates or anatomical locking compression plates. Locking plates allow the opportunity to combine dynamic compression principles with internal fixation using locking screws.…”

Section: Introductionmentioning

confidence: 99%

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Operative Fixation of Lateral Malleolus Fractures With Locking Plates vs Nonlocking Plates: A Systematic Review and Meta-analysis

et al. 2021

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Background: The exact benefit of locking plates over nonlocking plates in patients with lateral malleolus fractures remains unclear. The primary aim of this study was to compare the functional outcome of locking plates vs nonlocking plates in patients with a lateral malleolus fracture. The secondary aims were to compare the number of complications and hardware removals and to compare whether results differed for older patients and for patients treated with anatomical locking plates. Methods: The PubMed/MEDLINE, Embase, Cochrane, and CINAHL databases were searched for studies comparing locking plates with nonlocking plates in patients with fixated lateral malleolus fractures. All included studies were assessed on their methodologic quality using the MINORS. Subgroup analyses were performed on older patients and patients treated with anatomical locking plates. Results: A total of 11 studies were included. The meta-analysis showed that functional outcome did not differ between patients treated with locking plates and nonlocking plates (MD 2.38, 95% CI −2.71 to 7.46). No difference in both complication rate (OR 1.10, 95% CI 0.74-1.63) and the amount of hardware removals (OR 0.77, 95% CI 0.52-1.14) was found. Even after analyzing older patients and patients treated with anatomical locking plates, no benefit was shown. Conclusion: This meta-analysis demonstrates no clear benefit in selecting locking plates over nonlocking plates in the treatment of lateral malleolus fractures. Clinical Relevance: Locking plates are increasingly being used in the treatment of lateral malleolus fractures. Biomechanical studies have shown an increased stability with use of locking vs nonlocking plates. This clinical review does not support a benefit of use of locking plates for these fractures.

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Section: Searchmentioning

confidence: 99%

“…4,7,8,11,12,17,20,21,25,26,28 Ten of the included studies were retrospective cohort studies. 4,7,8,11,12,17,20,21,25,26 One of the included studies was a randomized controlled trial. 28…”

Section: Searchmentioning

confidence: 99%

Section: Functional Outcomementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Operative Fixation of Lateral Malleolus Fractures With Locking Plates vs Nonlocking Plates: A Systematic Review and Meta-analysis

et al. 2021

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“…For patients whose growth plates are not closed yet, threaded screws pose a risk of injury to the growth plate [11]. Furthermore, the commonly used distal bula anatomical locking compression plate (LCP), which is relatively large and must be positioned relatively superior according to the instruction manual, is also not appropriate for these fractures because sometimes the screws are not su cient to secure the distal bular fragment [12]. Therefore, su cient internal xation options with which to treat avulsion fractures of the tip of the lateral malleolus are lacking.…”

Section: Introductionmentioning

confidence: 99%

Locking Compression Plate Distal Ulna Hook Plates as Alternative Fixation for Avulsion Fractures of the Tip of the Lateral Malleolus

Shui

Luo

Yang

et al. 2020

Preprint

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Background: Because of the fragment size and inferior location of the fracture lines, options are lacking for internal fixation to treat avulsion fractures of the tip of the lateral malleolus. Because the anatomical architecture of the distal malleolus is similar to that of the distal ulna metaphysis, the purpose of this study was to assess the effectiveness of 2.0-mm locking compression plate distal ulna hook plates in treating avulsion fractures of the tip of the lateral malleolus.Methods: Given the characteristics of the 2.0-mm locking compression plate distal ulna hook plate, cases in which the distance between the fracture lines and the distal end of the tip of the lateral malleolus was less than 6 mm were excluded. Seventeen patients (AO Foundation/Orthopaedic Trauma Association (AO/OTA) 44A fractures, 13 males, 4 females, median age 41 years range 18-73 years) with avulsion fractures of the tip of the lateral malleolus were included. All patients were treated with fixation of the fragment to the fibula using a 2.0-mm locking compression plate distal ulna hook plate. Clinical and radiological follow-up visits were conducted at 6 weeks and 3, 6, 12 and 24 months after the operation. Results: The mean American Orthopedic Foot and Ankle Society Ankle-Hindfoot score of the patients was 97.06±1.92 (range 94 to 100) at the 12-month postoperative follow-up and 97.71±1.54 (range 96 to 100) at the 24-month postoperative follow-up. The mean Karlsson score was 94.18±3.88 (range 90 to 100) at the 12-month postoperative follow-up and 96.43±2.34 (range 95 to 100) at the 24-month postoperative follow-up. Nonunion was not noted; 6 patients complained of lateral malleolar discomfort and foreign body sensation, and 3 of these patients underwent a hardware removal operation at 12 months postoperatively. All patients were clinically and radiographically stable.Conclusion: A 2.0-mm locking compression plate distal ulna hook plate achieved stable and anatomically suitable fixation and should be considered as an alternative treatment for avulsion fractures of the tip of the lateral malleolus.

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The Influence Mechanism of Screw Internal Fixation on the Biomechanics of Lateral Malleolus Oblique Fractures

Shi,

Wang,

Gong

et al. 2024

Numer Methods Biomed Eng

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It remains inconclusive about the stability and optimal fixation scheme of screw internal fixation for lateral malleolus oblique fractures in clinical practice. In this study, the effects of different screw internal fixation methods on the biomechanics of lateral malleolus oblique fractures were investigated. These efforts are expected to lay a theoretical foundation for the selection of internal fixation methods and rehabilitation training regimens in the treatment of lateral malleolus fractures. A healthy ankle joint model and a lateral malleolus fracture internal fixation model were established based on CT data with the aid of some software. Besides, the effects of screw internal fixation modalities on the fracture displacement of fibula fractures, fibula Von Mises stress, and screw Von Mises stress under different physiological conditions and loading conditions were investigated using finite element methods (FEMs) and in vitro physical experiments. The double screw vertical fibular axis internal fixation approach had the lowest fracture displacement of fibula fractures and screw Von Mises stress values; while the double screw vertical fracture line internal fixation approach had the lowest fibula Von Mises stress values. Under different physiological conditions, the magnitude of the peak Von Mises stress of the fibula and screw was ranked as plantarflexion 20° > plantarflexion 10° > neutral position > dorsiflexion 10° > dorsiflexion 20°; and the magnitude of the peak displacement of the fibula fracture breaks was ranked as plantarflexion 20° > plantarflexion 10° > neutral position > dorsiflexion 20° > dorsiflexion 10°. The results of in vitro physical experiments and finite element analyses were in good agreement, which validated the validity of finite element analyses. The vertical fracture line screw implantation method displays a better load‐sharing ability; while the vertical fibular axis screw implantation method exhibits a better ability to prevent axial shortening of the fibula and also reduces the risk of screw fatigue damage. Overall, the double screw achieves better therapeutic effects than the single screw. Given that the ankle joint has high stability in the dorsiflexion position, it is recommended to prioritize dorsiflexion rehabilitation training, rather than dorsiflexion and plantarflexion rehabilitation training with too large angles, in the treatment of lateral malleolus fractures.

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Comparison of different locking plate fixation methods in lateral malleolus fractures

Cited by 20 publications

References 27 publications

Operative Fixation of Lateral Malleolus Fractures With Locking Plates vs Nonlocking Plates: A Systematic Review and Meta-analysis

Operative Fixation of Lateral Malleolus Fractures With Locking Plates vs Nonlocking Plates: A Systematic Review and Meta-analysis

Locking Compression Plate Distal Ulna Hook Plates as Alternative Fixation for Avulsion Fractures of the Tip of the Lateral Malleolus

The Influence Mechanism of Screw Internal Fixation on the Biomechanics of Lateral Malleolus Oblique Fractures

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