Fewer reoperations after posterolateral plate positioning compared with lateral plate positioning in ankle fractures-a retrospective study on 453 AO/OTA 44-B injuries

Comparison of operatively and nonoperatively treated isolated Weber B ankle fractures: a systematic review and meta-analysis

BACKGROUND

Despite fractures of Isolated Weber B being prevalent, there is a lack of clarity regarding the relative effectiveness of surgical versus conservative treatment. This systematic review and meta-analysis aimed to investigate the clinical effects and complications of surgical versus conservative treatment of the Isolated Weber B ankle fractures.

METHODS

This study involved thorough searches across multiple electronic databases, including PubMed, Cochrane, Embase, and Web of Science, to identify all relevant publications on Isolated Weber B ankle fractures repaired through surgical versus conservative treatment. Through a comprehensive meta-analysis, several outcomes were evaluated, including post-operative function, complications and reoperation rate.

RESULT

Six articles involving 818 patients who met the inclusion criteria. Among these participants, 350 were male and 636 were female. 651 patients received conservative treatment, while 396 underwent surgical intervention. The findings indicate no significant differences in OMAS, FAOQ, PCS, MCS scores, and return to work between surgical and non-surgical treatments for isolated Weber B ankle fractures. However, compared with surgical treatment, non-surgical treatment has a higher AOFAS score(MD = -5.31, 95% CI = [-9.06, -1.55], P = 0.20, I2 = 39%), lower VAS score(MD = 0.72, 95% CI = [0.33, 1.10], P = 0.69, I2 = 0%), lower complication rate (RR = 3.06, 95% CI = [1.58, 6.01], P = 0.05, I2 = 54%), and lower reoperation rate(RR = 8.40, 95% CI = [1.57, 45.06], P = 0.05, I2 = 67%).

CONCLUSION

Three-dimensional morphological study of type B lateral malleolar fractures with special reference to the end-tip location of proximal apexes

Objective: We aimed to describe the morphological characteristics of Danis-Weber type B lateral malleolar fractures, with special attention given to the end-tip locations of fracture apexes, and to construct a 3D (three-dimensional) fracture line map. Methods: A total of 114 surgically treated cases of type B lateral malleolar fractures were retrospectively reviewed. The baseline data were collected, and computed tomography data were reconstructed in a 3D model. We measured the morphological characteristics and the end-tip location of the fracture apex on the 3D model. All the fracture lines were superimposed on a template fibula to generate a 3D fracture line map. Results: Among these 114 cases, 21 were isolated lateral malleolar fractures, 29 were bimalleolar fractures, and 64 were trimalleolar fractures. All the type B lateral malleolar fractures demonstrated a spiral or oblique fracture line. As measured from the distal tibial articular line, the fracture started at -6.22 ± 4.62 mm anteriorly and terminated at 27.23 ± 12.32 mm posteriorly, and the average fracture height was 33.45 ± 11.89 mm. The fracture line inclination angle was 56.85° ± 9.58°, and the total fracture spiral angle was 269.81° ± 37.09°, with fracture spikes of 156.20° ± 24.04°. The proximal end-tip location of the fracture apex was classified into four zones in the circumferential cortex: zone I (lateral ridge) in seven cases (6.1%), zone II (posterolateral surface) in 65 cases (57%), zone III (posterior ridge) in 39 cases (34.2%), and zone IV (medial surface) in three cases (2.6%). Altogether, 43% (49 cases) of fracture apexes were not distributed on the posterolateral surface of the fibula, as 34.2% (39 cases) were located on the posterior ridge (zone III). The aforementioned morphological parameters in fractures with zone III, sharp spikes, and further broken spikes were greater than those in zone II, blunt spikes, and fractures without further broken spikes. The 3D fracture map suggested that the fracture lines with the zone-III apex were steeper and longer than those with the zone-II apex. Conclusion: Nearly half of type B lateral malleolar fractures had their proximal end-tip of apexes not on the posterolateral surface, which may impair the mechanical application of antiglide plates. A steeper fracture line and longer fracture spike indicate a more posteromedial distribution of the fracture end-tip apex.

Posterior Antiglide Plating vs Lateral Neutralization Plating for Weber B Distal Fibular Fractures: A Systematic Review and Meta-analysis of Clinical and Biomechanical Studies

BACKGROUND

Distal fibular fractures are extremely common, yet there remains controversy about which type of plating technique is the most appropriate. We aimed to compare clinical and biomechanical outcomes following posterior antiglide plating and lateral neutralization plating for Weber B distal fibular fractures.

METHODS

A systematic review and meta-analysis of the literature was conducted by two independent reviewers according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We included all comparative studies of distal fibular fracture fixation with either a posterior antiglide plate or a lateral neutralization plate. Our primary outcome of interest was reoperation for hardware removal. Secondary outcomes included hardware discomfort, peroneal tendon irritation, infection, wound complications, and mechanical torque to failure.

RESULTS

A total of 1122 patients with Weber B ankle fractures were included across nine eligible clinical studies, and 76 cadaveric ankles were subject to testing across three eligible biomechanical studies. Meta-analyses revealed a two-fold greater odds of requiring removal of hardware in the lateral plating group compared to the posterior plating group (odds ratio [OR] 2.48, 95% CI 1.58 to 3.91, P < .0001), and a three-fold greater odds of experiencing hardware discomfort in the lateral plating group compared to the posterior plating group (OR 2.96, 95% CI 1.83 to 4.80, P < .0001). There were no significant differences in rates of peroneal tendon irritation, infection, wound complications, operative time, and torque to failure when comparing the two plating methods.

CONCLUSION

The results of this review indicate that using posterior antiglide plating for distal fibular Weber B-type fractures is associated with significantly fewer reoperations due to hardware complications and less hardware discomfort compared to lateral neutralization plating. This technique does not appear to increase the risk of peroneal tendon irritation or increase operative time.