Comparison of three plate system for lateral malleolar fixation

Abstract

BackgroundThis study was to compare clinical and radiographic outcomes with three different implants and evaluate the effectiveness of minimally invasive plate osteosynthesis (MIPO) technique for the distal fibular fractures.MethodsWe performed a retrospective cohort single-surgical team single-facility study between 2000 and 2011. 147 patients receiving surgical interventions for closed, displaced distal fibular fractures were included. Based on the different implants, patients were divided into three groups: Group A: one-third tubular plate; Group B: locking compression (LCP) metaphyseal plate; Group C: LCP distal fibula plate. Clinical and radiographic outcomes were compared among the three groups.ResultsTotally, we found that patients in Group C had significant higher functional scores than those in Group A (p1 = 0.004; p2 = 0.002) (p1 stands for the p value for Olerud & Molandar Score, p2 stands for the p value for American Orthopaedic Foot & Ankle Society score). The healing time was significant less in Group C than that in Group A (p < 0.0001) and Group B (p < 0.0001). Subgroup analysis showed that: (1) For Weber A fracture, the functional scores of the Group C were higher than those in Group A (p1 = 0.020; p2 = 0.029) and B (p1 = 0.020; p2 = 0.034). (2) For Weber B fracture, the functional scores of the Group B (p1 = 0.033; p2 = 0.030) and C (p1 = 0.027; p2 = 0.017) were higher than those in Group A. No significant differences were observed in terms of the ankle range of motion, reduction accuracy and complication rate.ConclusionsOur study demonstrated using LCP metaphyseal plate in patients associated with lateral malleolar fracture could achieve significantly better OMS & AOFAS scores and less healing time than using one-third tubular plate. Specifically, For Weber A fracture, LCP distal fibula plate is much better than one-third tubular plate and LCP metaphyseal plate. While for Weber B fracture, LCP distal fibula plate and LCP metaphyseal plate are better than one-third tubular plate. As to the complications, using MIPO technique in patients with distal fibular fractures is at least comparable to the traditional one.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2474-15-360) contains supplementary material, which is available to authorized users.

Minimally Invasive Surgical Approach Using an Equal-Sized Plate as an External Guide to Lateral Malleolar Fractures

“…Because the incision scar exactly coincided with the head of the screw, it was not difficult to remove the screw with the mini incision. The present AOFAS values are observed to be better than those from Chiang et al, 1 Pires et al, 6 and Huang et al 4 However, in the present study, all of the patients had isolated lateral malleolar fractures, and in these three publications, patients had other ankle trauma in addition to lateral malleolar fractures. In studies that present only lateral malleolar fracture open surgery results, the AOFAS scores are close to the present results.…”

“…It was observed that in the literature studies of fixation of the malleolus lateralis with a percutaneous plate, an external guide was not used. 1,[4][5][6][7][8] With the present technique, an equal-sized plate was used as an external guide. With this technique, the use of an equal-sized plate as an external guide ensured less exposure to fluoroscopy during determination of the incisions and screwing.…”

“…An unwanted complication of open surgery for fractures of the lateral malleolus is nonunion. 4,5 Huang et al 4 stated there was more pain in the early postoperative period with open surgery. In the present patients, nonunion or delayed union was not observed.…”

“…Because the fracture line is not opened with the MIPPO technique, the patients had less pain. 4 Less pain means less nonsteroidal anti-inflammatory drug use; as a result, the negative effects of nonsteroidal antiinflammatory drug use on fracture healing are excluded. We believe that this may have prevented the observation of complications such as nonunion and delayed union.…”

Treating AO/OTA 44B lateral malleolar fracture in patients over 50 years of age: periarticular locking plate versus non-locking plate

“…However, for OTA 44-B and 44-C lateral malleolar fractures, the biomechanical superiority of locked lateral plates cannot be demonstrated when compared with conventional lateral plates in a meta-analysis of biomechanical studies using osteoporotic cadaver models [29]. Up to date, there are several studies evaluating the clinical outcomes in lateral malleolar fractures treated with and without locking plates [3,4,13,22,23,26,[30][31][32] (Supplemental Table 3). However, the reported results vary under the different inclusion criteria for fracture type and implant type.…”