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

Abstract

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.

Keywords: Ankle fracture; Locking plate; Distal fibula fracture; Outcome; Complications; Osteoporosis

Core Tip: Ankle fractures are common injuries in the young and elderly populations. Fibula locking plate is used for the older population due to osteoporotic bone or for the younger population with multifragmentary and comminuted fractures. We introduced a new locking plate for fracture of the distal fibula and evaluated it for lateral malleolar fixation in terms of outcomes and complications in young and elderly patients. We were interested in determining whether the use of this locking plate would provide the same advantage and outcomes that were described in literature.