A Specialized Fibular Locking Plate for Lateral Malleolar Fractures

Locking plates for distal fibula fractures in young and elderly patients: A retrospective study

BACKGROUND

Ankle fractures are common injuries in the young and elderly populations. To prevent post-traumatic arthritis, an anatomic reconstruction of the ankle structure is mandatory. Open reduction and internal fixation is the treatment of choice among orthopaedics. Conventional plates allow stability of the fracture if bone quality is present. Locking plates might offer an advantage for the treatment of lateral malleolar fracture in patients with comminution, severe instability, distal fractures, or osteoporotic bone. Our hospital introduced a new locking plate for fracture of the distal fibula.

AIM

To evaluate locking plates in terms of outcomes and complications in young and elderly patients.

METHODS

We retrospectively reviewed a total of 67 patients treated for displaced distal fibula fractures. Demographic data, number of comorbidities, use of inter fragmentary screw, complication, time of fracture healing, partial or full weight bearing, and reoperation were recorded for all patients. Clinical outcome was assessed by the American Orthopedic Foot and Ankle Society clinical scoring system. Radiographs were obtained at 4, 8, 12, 16, 20, and 24 wk until radiographic union was obtained.

RESULTS

All patients displayed complete bony union on radiographic assessment, and no patients developed any serious complications. We observed two superficial infections, one delayed wound healing, and two plate intolerances. Significant differences were observed between the two age groups in terms of radiographic healing (11.9 wk in younger patients vs 13.7 wk in older patients; P = 0.011) and in the American Orthopedic Foot and Ankle Society score at 6 mo after surgery (88.2 in younger patients vs 86.0 in older patients; P = 0.001) and at 12 mo after surgery (92.6 in younger patients vs 90.0 in older patients; P = 0.000).

CONCLUSION

Locking plates provide a stable and rigid fixation in multifragmentary and comminuted fractures or in the presence of poor bone quality.

A Prospective Randomized Study Comparing Functional Outcome in Distal Fibula Fractures between Conventional AO Semitubular Plating and Minimal Invasive Intramedullary "Photodynamic Bone Stabilisation"

(1) Background: As age in western populations is rising, so too are fractures, e.g., of the distal fibula. The aim of this study was to find out whether a novel, minimally invasive intramedullary osteosynthesis technique for the treatment of distal fibula fractures in elderly patients results in not only a reduction of postoperative complications, but also a shorter hospitalization time, an improved clinical outcome, and preserved autonomy in geriatric trauma patients. (2) Methods: In this prospective study, the results following surgical treatment for distal fibula fractures in geriatric patients after using DePuy Synthes^® one-third semitubular plate (Group I) or a minimally invasive intramedullary photodynamic Bone StabilizationSystem (IlluminOss^®) (Group II) were compared at 6 weeks, 12 weeks, 6 months, and 1 year after initial treatment. (3) Results: Significant improvement regarding clinical outcome was shown in Group II 6 and 12 weeks after surgery. (4) Conclusions: Our study results demonstrate that the use of this new intramedullary stabilization system in combination with an immediate postoperative weight bearing seems to be a safe and stable treatment option for ankle fractures in geriatric patients, especially in the early stages of recovery.

Efficacy of hook-type locking plate and partially threaded cancellous lag screw in the treatment of displaced medial malleolar fractures in elderly patients

INTRODUCTION

Traditionally, partially threaded cancellous lag screws (PTCS) are used for most medial malleolar fractures but are often challenging to execute in elderly patients because of the high risk of postoperative complications. Limited literature explores whether hook-type locking compression plates (LCPs) reliably offer better outcomes than PTCS in elderly patients. We aimed to compare the midterm radiologic and clinical outcomes between hook-type LCP and PTCS for medial malleolar fractures in an elderly population.

METHODS

We included 258 patients, aged 65 years and above, treated with either a hook-type locking plate (hook LCP group: 121 patients) or PTCS (screw group: 137 patients), and with follow-ups of at least 36 months in this retrospective study. Radiographic assessments included the union rate and interval to fracture union. Clinical assessment included the postoperative complications and revision procedures.

RESULTS

Although a significantly higher rate of comminuted fractures was observed in the hook LCP group than in the screw group (p < .001), no significant difference in the union rate was observed between the two groups (hook LCP group: 93.4% vs. screw group: 89.8%, p = .151), and a significantly shorter interval to union was observed in the hook LCP group (10.2 ± 7.0 vs. 12.3 ± 6.7 weeks, p = .015). There was a trend toward a lower rate of complications, including revision procedures, in the hook LCP group than in the screw group (19.9% vs. 28.5%, p = .107 and 6.6% vs. 13.8%, p = .074).

CONCLUSION

Hook-type LCP may be an alternative option for treating medial malleolar fractures with comminution in elderly patients.

Metallosis after using distal fibular locking plate for lateral malleolar fractures: a retrospective study

INTRODUCTION

Studies regarding the development of metallosis following open reduction and internal fixation (ORIF) of fractures are rarely found in orthopedic literature. The aim of the current study was to assess metallosis following ORIF using distal fibular locking plates to treat distal fibular fractures.

MATERIALS AND METHODS

69 patients who underwent surgery using locking compression plates to treat lateral malleolar fractures, with a minimum 1-year follow-up period and subsequent hardware removal were enrolled in our study. We divided the patients into 2 groups, to compare the complications and demographics: 38 patients, treated with ZPLP plate; 31 patients, treated with other plates.

RESULTS

During 1 year of postoperative follow-up, 20 complications developed: 6 superficial infections at the operative site, 1 case of nonunion, 3 cases of osteitis, 4 cases of hypaesthesia, 2 cases of peripheral neuropathy, and 4 cases of metallosis. No statistical difference was found in the rate of complications when comparing the treatment groups (Mann-Whitney U test, p < .05) except for metallosis. All 4 patients who developed metallosis were treated using a ZPLP plate, and metallosis did not develop at all in patients who underwent surgery using other plates.

CONCLUSION

In our study, metallosis developed more than was previously known, particularly after using LCPs to treat lateral malleolar fractures. Our findings and those in recent publications support the possibility that metallosis can occur not only in patients with arthroplasties, but also in patients with open reduction and internal fixation with LCPs. Surgeons should be aware of such risk of metallosis and be careful to select proper plates for internal fixation.

One-Third Tubular Plate Remains a Clinically Good Option in Danis-Weber Type B Distal Fibular Fracture Fixation

OBJECTIVE

To compare the clinical outcomes of locking plate (LP) and non-locking one-third tubular plate (TP) fixation, and to provide guidance on plate selection for Danis-Weber type B distal fibular fracture treatment.

METHODS

In total, 83 patients who underwent plate fixation for Danis-Weber type B distal fibular fractures between March 2013 and July 2018 were retrospectively reviewed: 41 (49.0%) received LPs and 42 (51.0%) received TPs. Patients' demographic data, follow-up durations, the proportion of comminuted fractures, and ankle range of motion were investigated. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, Karlsson scale, Foot and Ankle Ability Measure (FAAM), and Lower Extremity Functional Scale (LEFS) scores were assessed. The radiographic union progression and implant removal time were evaluated, along with postoperative complications. Data from the LP and TP groups were compared statistically.

RESULTS

The mean patient ages were 53.3 ± 17.5 years (range, 16-80 years) and 47.6 ± 17.0 years (range, 14-68 years) in the LP and TP groups, respectively (P > 0.05). The gender distribution did not differ significantly between groups (P > 0.05). Other demographic data also did not differ significantly between groups (P > 0.05). The mean follow-up durations were 16.8 ± 7.7 months (range, 13.0-19.0 months) in the LP group and 16.1 ± 6.2 months (range, 12.0-20.0 months) in the TP group (P > 0.05). Comminuted fractures were observed in 18 of 41 (43.9%) patients with LP and 10 of 42 (23.8%) patients with TP (P > 0.05). Forward bending ankle dorsiflexion was possible at the final follow-up in 82.9% and 85.7% of LP and TP patients, respectively (P > 0.05). The AOFAS ankle-hindfoot scale, Karlsson scale, FAAM, and LEFS scores did not differ significantly between groups at the final follow-up (P > 0.05). The pre-fracture and final postoperative scores on these four instruments did not differ significantly in the LP or TP group (P > 0.05). The mean times to radiographic union progression were 13.5 ± 7.1 weeks and 15.1 ± 10.2 weeks in the LP and TP groups, respectively (P > 0.05). The mean times to implant removal surgery reaffirming solid union were 15.6 ± 5.5 months and 14.8 ± 4.9 months in the LP and TP groups, respectively (P > 0.05). Hardware irritation was detected in five patients in the LP group (12.2%) and three in the TP group (7.1%) (P > 0.05). One patient in the LP group and two in the TP group developed superficial wound infections, which resolved without further surgical intervention.

CONCLUSION

Conventional TP remains a good option for the fixation of Danis-Weber type B distal fibular fractures, regardless of the biomechanical properties.

Is early full weight bearing safe following locking plate ORIF of distal fibula fractures?

Background

In the modern western world appraisal of economical points such as treatment and disability after trauma present a financial burden. In this context open reduction internal fixation techniques allowing for early full weight bearing might not only improve the clinical outcome but also shorten the period of disability in working life. The aim of the study was to analyze whether ORIF of ankle fractures using either a standard semitubular plate or a new polyaxial locking plate system result in a better clinical outcome.

Methods

In this prospective study, all patients with distal fibula fractures (AO 44 B1.1, B1.2, B1.3), with indication for surgery were included. Patients were randomized to either the DePuy Synthes® one-third semitubular plate (Group I) or NEWCLIP TECHNICS, Active Ankle® polyaxial locking plate (Group II). Primary outcome parameter was function of the ankle joint, assessed by the Olerud and Molander ankle score, Foot and Ankle outcome score and Karlsson and Peterson Scoring System for Ankle function. Secondary outcome parameter were postoperative complications. Superficial wound infection, delayed wound healing, mechanically prominent implant, skin irritations were considered as minor and deep wound infection, material loosening, loss of reduction were regarded as major complications requiring revision surgery. Clinical and radiological follow-up were performed 6 and 12 weeks, 6 months and 1 year postoperatively.

Results

Fifty-two patients (31 W/21 M) with a mean age of 43 yrs. (range 22–64 yrs.) were enrolled. Seven patients (13.5%) were excluded, so that 45 patients were available for follow up. Twenty-five patients were treated with DePuy Synthes® one-third semitubular plate (55.6%; group I) while 20 patients received an anatomically preformed polyaxial locking plate (44.4%, group II). Four minor complications occurred in Group I (16%) compared to two minor complications in group II (10%). Significant better clinical results regarding OMAS (p < 0.02, < 0.04), KPSS (p < 0.04) and FAOS (p < 0.02, < 0.03) were observed 6 and 12 weeks after surgery in group II.

Conclusions

The results of the presented study demonstrate a significant better clinical functional outcome in the early postoperative follow-up in patients treated with a polyaxial locking plate. Furthermore, our data show that ORIF using polyaxial locking plates in combination with an early postoperative weight bearing presents a safe, stable treatment option for ankle fractures so that patients benefit especially in the early stages of recovery.

Trial registration

Registered 20 April 2020, retrospectively on ClinicalTrails.gov (NCT04370561).

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

Background

The role of locking plate in lateral malleolar fracture fixation for the elderly remains unclear. The aim of our study is to compare radiological and functional outcomes in older patients (> 50 years) with AO/OTA 44B lateral malleolar fractures after locking plate (PLP) or one-third non-locking tubular plate (TP) lateral fixation.

Methods

We retrospectively reviewed the medical records of 72 patients (PLP group, 34 patients; TP group, 38 patients; mean age, 61.9 ± 7.6 years; range, 51–80 years; follow-up, 1 year). Patients with open fractures, syndesmosis injuries, and a previous ankle trauma or surgery were excluded. Demographic data, union rate, complications, radiographic outcomes, visual analog scale (VAS) scores, and foot and ankle outcome scores (FAOSs) between the groups were recorded and compared. We also investigated the association of clinical features with pain and function. Statistically, the Fisher’s exact test was used for categorical variables and the Mann-Whitney U test for the continuous variables. The final model for the multiple regression analysis was used to predict factors related to functional outcomes.

Results

There were no significant between-group differences in demographic data, complication rates, immediately postoperative distal fibula lengths, ankle osteoarthritis (OA) grades, talar tilt angles (TTAs) ≥ 2°, or reduction accuracy. All fractures achieved union. The PLP group had significantly lower rates of distal screw loosening, fibula shortening > 2 mm, OA grade progression, and TTAs ≥ 2°, and better FAOSs and VAS scores than was the case for the TP group after 1 year of follow-up (all p < 0.05). The severity of OA, TTA ≥ 2°, and distal screw loosening were positively associated with VAS scores, and negatively associated with FAOSs.

Conclusions

When treating AO/OTA 44B fractures in patients over 50 years of age, PLPs provided better VAS scores, FAOSs, and radiological outcomes, including less fibula shortening > 2 mm, less osteoarthritic (OA) ankle progression, less implant removal rate, and fewer TTAs ≥ 2° than was the case for TPs after a 1-year follow-up.

Level of evidence

Therapeutic level III

Locking versus non-locking one-third tubular plates for treating osteoporotic distal fibula fractures: a comparative study

INTRODUCTION

Ankle fractures represent the third most common fracture in elderly patients, after hip and wrist fractures. Distal fibula fractures in this population are closely related to osteoporosis, which renders commonly used methods of internal fixation technically demanding and prone to failure. Currently there is a tendency to fix osteoporotic metaphyseal and epiphyseal fractures with locking plates. However, published accounts about the use of this technology in osteoporotic distal fibula fractures are scarce. In this study we compare the results of two groups of patients who underwent surgery for these types of fracture, one group received locking and the other non-locking screws, both using one-third tubular plates.

METHODS

Sixty-two patients, aged over 64 years, underwent surgery for osteoporotic distal fibula fractures between 2011 and 2014. Forty-five of them were stabilized with a non-locking plate and the remaining 17 with a locking plate fixation. Follow-up was performed at 4, 8, 12, 26, and 52 weeks. Results were assessed according to the AOFAS Ankle-Hindfoot Score and radiological criteria for consolidation.

RESULTS

Average time to union and AOFAS scores at 6 and 12 months were similar in both groups, including for the individual categories: function, pain, mobility, and alignment. Only time until partial weight bearing was significantly lower in the locking plate group (4.69 ± 2.63 vs 7.77 ± 4.30, p = 0.03). The most common complications were wound dehiscence and superficial infection (two cases of both).

CONCLUSIONS

Both locking and conventional non-locking plates achieved similar treatment outcomes in this group of osteoporotic patients aged over 64. However, locking plates may offer more benefits in cases that have to take into account immobilization time and concomitant soft-tissue damage.