Plate Versus Lag Screw Only Fixation of Unstable Ankle Fractures Involving the Fibula in Adolescent Patients

Abstract

Background: Plate fixation has been the traditional technique for fracture repair of unstable ankle injuries with an associated lateral malleolus fracture. Recently, biomechanical and clinical data have demonstrated lag screw only fixation to be an effective alternative to plate fixation in the adult population. This comparison has yet to be studied in the adolescent or pediatric population. The objective of this study was to compare lag screw only fixation with traditional plating for lateral malleolus fractures in adolescents. Methods: A retrospective review was conducted of 83 adolescents with unstable oblique lateral malleolus fractures treated at a single pediatric level-1 trauma center between 2011 and 2019 with a minimum clinical follow-up until fracture union. Patients were divided into 2 surgical groups: (1) plate fixation (n=51) or (2) lag screw fixation (n=32). Radiographic and clinical outcomes and complications were measured in both groups. Results: All patients in both groups achieved our primary outcome measure of fracture union without loss of reduction. The mean surgical time for subjects treated with a plate was 15 minutes longer (64 vs. 49 min) (P=0.001) and these patients were 3.8 times more likely to have symptomatic implants (P<0.044) than subjects treated with screws. Approximately 50% of the cohort was available by phone for patient-reported outcomes at a mean follow-up of 50 months. The mean Single Assessment Numerical Evaluation scores, Foot and Ankle Ability Measure Activities of Daily Living scores, Foot and Ankle Ability Measure sports scores, and return to sports rates were similar (92 vs. 93, 98.2 vs. 98.1, 93.2 vs. 94.0, 95% vs. 86%, respectively; P>0.05) between the 2 treatment methods. Conclusions: Lag screw only fixation is a safe and effective procedure for noncomminuted, oblique fibula fractures in the adolescent population as demonstrated by equivalent fracture healing rates without loss of reduction and similar outcome scores. Given these comparable results with the additional benefits of shorter surgical time and less symptomatic implants, lag screw only fixation should be considered as a viable treatment alternative to traditional lateral plating in the adolescent population. Level of Evidence: Level III.

[Retracted] Analysis of the Effect of Posterior Lateral Malleolus Plate Fixation on the Curative Effect and Mechanical Stability of Complex Ankle Fractures

“…The traditional application of single screw fixation can play the role of compression at the broken end, but the weakness of this method lies in its low stability and antirotation ability. Although tension band steel wire has antirotation ability, it has a high risk of wire fracture, which may cause serious complications, leading to poor safety [ 8 ]. Tubular steel plate is a new fixation material with good fixation and antirotation ability and is not easy to break.…”

What’s New in Pediatric Orthopaedics

“…In a series of 83 patients, an alternative technique of lag screws alone for the management of unstable lateral malleolar fractures was compared with traditional plate fixation. Both groups had 100% union rates without a loss of reduction; however, the mean surgical time was longer in the plate group at 64 minutes compared with the lag screw group at 49 minutes (p = 0.001), and the plate group was 3.8 times more likely to have symptomatic implants (p < 0.044) than the lag screw group 8 .…”

What is New in Pediatric Orthopaedic Foot and Ankle

“…61 Ankle fractures needing surgical intervention have relatively good outcomes in children, especially those with open physes. 62 Paez et al 63 demonstrated that since skeletally immature patients have robust healing potential, lag screw fixation for unstable distal fibular fractures in adolescents without plating can be successful.…”