Outcome Analysis of Fixed Angle Locking Plate in Patella Fractures: A Single Centre Experience from North India

BackgroundTension band wiring supposedly is the most commonly used technique for displaced patella fractures, but is not effective in comminuted fractures and osteoporotic bones. It often leads to loosening of wires, dislocation of fracture, hardware problem and failure of osteosynthesis, resulting in knee stiffness and post-traumatic osteoarthritis. The aim of the study is to evaluate clinical outcome in patients with acute patella fractures (< 3 week) treated with unidirectional angle fixed low-profile titanium patella locking plate.Materials and methodsTwenty patients who presented with displaced patella fractures, aged between 18–70 years were included in the study. All fractures were reduced and fixed with unidirectional angle fixed stable low-profile titanium patella locking plate. Knee Range of motion and Knee Outcome Survey Activities of Daily Living Scale (KOS-ADL) was used to evaluate the outcome.ResultsWe were able to achieve union in 19 out of 20 patients. One patient with comminuted patella fracture had failure of fixation, which was revised. Mean flexion at final follow-up was 124° (110°–130°) and none of the patients had extensor lag. The final radiograph revealed complete union in all patients.ConclusionThis technique offers an option of fixation in comminuted patella fracture and in osteoporotic individuals. It provides mechanical stability for fracture fixation resulting in anatomical reduction, good functional outcome, lower incidence of symptomatic implant or failure of osteosynthesis.     

Netzwerkpartner Arbeitstherapeut im Rehabilitationsmanagement

Due to the functional importance of the patella, accurate reduction and rigid fixation of patellar fractures are required. Tension band wiring has long been the standard treatment of these fractures, but there are several problems associated with this technique, e.g. loosening of the wires, fracture dislocation and poor outcome. Another possibility in the treatment of transverse patellar fractures is screw fixation. Although this technique ensures stable osteosynthesis, anatomical reduction is often problematic, especially in comminuted fractures. A good option in the treatment of (comminuted) patellar fractures is the newly designed locking patella plate, which combines anatomical reduction and stable osteosynthesis. In biomechanical tests the plate provided a more stable fixation of the patellar fracture and showed higher mechanical strength compared to classic tension band wiring. The first clinical applications achieved optimal fracture reduction. No complications have occurred to date following the use of the plate. Thus the patella plate represents a good option in the treatment of patellar fractures.     

双环10号线环扎并分体式髌骨爪治疗髌骨粉碎骨折

目的:观察双环10号线环扎并分体式髌骨爪治疗髌骨粉碎骨折的临床疗效。方法:自2004年6月至2011年6月,采用双环10号线环扎并分体式髌骨爪治疗髌骨粉碎骨折86例,其中男48例,女38例;年龄19～75岁,平均42.5岁;左侧52例,右侧34例。86例患者均为粉碎性骨折,3个骨折块者25例,4个骨折块者32例,4个以上骨折块者29例。手术时间40～70 min。所有病例术后根据B觟stman等髌骨骨折疗效评价标准进行评分。结果:86例全部得到随访,时间3个月～6年,平均3.5年。B觟stman评分总平均分(27.65±2.05)分,优78例,良8例。结论:双环10号线环扎并分体式髌骨爪治疗髌骨粉碎骨折具有手术简单、复位良好、固定稳定的优点,可早期进行锻炼,关节功能恢复满意。     

Outcome of low profile mesh plate in management of comminuted displaced fracture patella

PurposeTo assess the clinical results of using mesh plate in management of displaced comminuted fracture patella.Patients and methodsBetween January 2014 and October 2015, nine patients with closed displaced comminuted fracture patella were fixed using mesh plate and 2 mm mini screws.ResultsAll fractures united after an average of 10 weeks. At final follow-up of an average 19.6 months, average postoperative Lysholm score was 89.1 ± 4.9, and average Postoperative Böstman scale was 27.2 ± 3.1. No hardware related complications were recorded.ConclusionLow profile mesh plate is a good option in management of comminuted fracture patella with good clinical outcome. This new surgical technique may be particularly useful in comminuted fractures when patellectomy would otherwise be considered.     

Management of comminuted patellar fracture with non-absorbable suture cerclage and Nitinol patellar concentrator

PurposeTo evaluate the effectiveness and safety of a fixation technique for comminuted patellar fracture using non-absorbable suture cerclage and nickel-titanium patellar concentrator (Ni-Ti PC).MethodsTwenty-nine consecutive patients with displaced comminuted patellar fractures accepted internal fixation procedure using Ni-Ti PC augmented with different types of non-absorbable suture cerclage. During follow-up, the clinical grading scales of Böstman, including range of movement, pain, work, atrophy, assistance in walking, effusion, giving way, and stair-climbing, were used to evaluate the clinical results. Complications including implant loosening, fragment displacement, bone nonunion, infection, breakage of the implants, painful hardware, and post-traumatic osteoarthritis were also assessed.ResultsPatients were followed up for a mean period of 27 months. The bone union radiographically occurred approximately 2.5 months without implant loosening and fragment displacement. According to Böstman method, satisfactory results were obtained, and the mean score at final follow-up was 28 (range 20–30) points. Twenty-two patients with excellent results had mean score of 29.8 ± 0.5 (range 28–30) and seven patients with good results had mean score of 22.7 ± 3.14 (range 20–27). No postoperative complications, such as infection, dislocation, breakage of the implants, painful hardware, and post-traumatic osteoarthritis, were observed.ConclusionNi-Ti PC fixation with non-absorbable suture cerclage is a feasible approach for comminuted patellar fractures. Firm fixation with this technique resulted in satisfactory outcomes without obvious complications.     

A biomechanical evaluation of locked plating for distal fibula fractures in an osteoporotic sawbone model

BackgroundSupination external rotation (SER) injuries are commonly fixed with a one third tubular neutralization plate. This study investigated if a combination locked plate with additional fixation options was biomechanically superior in osteoporotic bone and comminuted fracture models.MethodsUsing an osteoporotic and a comminuted Sawbones model, SER injuries were fixed with a lag screw for simple oblique fibula fractures, and either a one third tubular neutralization plate or a locking plate. Samples were tested in stiffness, peak torque, displacement at failure, and torsion fatigue.ResultsThere was no statistically significant difference in biomechanical testing for fractures treated with a lag screw and plate. For comminuted fractures, locked plating demonstrated statistically significant stiffer fixation.ConclusionA combination locked plate is biomechanically superior to a standard one third tubular plate in comminuted SER ankle fractures. There was no biomechanical superiority between locked and one third tubular plates when the fracture was amenable to a lag screw.     

Outcome of open reduction and internal fixation of intraarticular calcaneal fracture fixed with locking cal- caneal plate

Objective：Debate continues regarding the management of calcaneal fractures,between open reduction and internal fixation and closed treatment.Hence we aim at evaluating the radiological and functional outcomes of open reduction and internal fixation in displaced joint depression type of calcaneal fractures fixed with locking calcaneal plate.Methods：In this series,28 patients （26 unilateral and 2 bilateral） with joint depression type of calcaneal fractures as per Essex-Lopresti classification system were operated on with locking calcaneal plate within 3 weeks of injury.Patients were evaluated in terms of associated injuries and X-rays of anteroposterior,lateral and axial views of the calcaneum.CT scan was done to assess the amount ofcomminution and articular depression.Patients were followed up clinically and radiologically at least for 1 year.Radiological assessment was done by Bohler＇s angle and Gissane＇s angle along with measurement ofcalcaneal height and width.Functional outcome was assessed using the American Orthopaedics Foot and Ankle Society （AOFAS） scale.Results：At average follow-up of 14.5 months,average AOFAS score was 86.3 （range 66 to 97）,with 86% having excellent to good results and 2 （7.7%） and 1 （3.7%） having fair and poor results respectively.All patients had stable ankle joint with all having dorsiflexion and plantar flexion more than 30°.Average subtalar range of motion was 17°.The mean Bohler＇s angle,mean Gissane＇s angle,calcaneal height and width were 25.47°,121.3°,4.32 cm and 3.81cm respectively at final follow-up.Three patients had flap necrosis at incision site and one had superficial and deep infection.Subtalar arthritis was seen in 5 patients,whereas sural nerve hypoaesthesia in 1 patient.None of the patients had compartment syndrome,heel pad problems,peroneal tendinitis,reflex sympathetic dystropy or implant failure.Conclusion：Open reduction and internal fixation with locking calcaneal plate gives sound functional outcome,i.e.restoring anatomically reconstruction of height,width,Bohler＇s and Gissiane＇s angles of the calcaneum,and allowing early mobilization.     

Open reduction and plating for displaced mid third clavicle fractures – A prospective study

IntroductionDisplaced middle third clavicle fractures were treated conservatively with figure of ‘8’ harness in the past. Current management trend in treating displaced clavicle fractures with internal fixation provide rigid immobilization and pain relief avoiding non-union, shortening and deformity. This study prospectively evaluates the functional outcome of 25 patients with clavicle fractures treated surgically.Materials and methods25 patients with displaced mid third clavicle fractures were included in the study. Open reduction and internal fixation with clavicular locking plate placed superiorly was done. Patients were followed up on 3, 6, 8, and 12 weeks. Functional outcome was assessed using DASH scores and Simple Shoulder Test (SST). Statistical analysis was done using One-way ANOVA.ResultsOut of the 26 clavicles operated (one patient had bilateral fracture), 6 were comminuted (23%) and the rest were 2 part displaced fractures. Interfragmentary screws were used in 3 cases with butterfly fragment. All fractures united (mean = 6.8 weeks). The DASH scores reduced to a significant negligible level by 8 weeks in all but 4 cases with comminution where it took longer than 8 weeks to reach negligible levels. The SST showed significant improvement in all cases by 8 weeks after surgery. All patients were satisfied with the outcome. 84% of patients returned to their work by 6 weeks.ConclusionPrimary plating of displaced mid third clavicle fractures with superiorly placed locking plate avoids complications of non-operative management and leads to early return to pre injury activities.     

锁定加压钢板(LCP)在桡骨远端粉碎性骨折中的应用

目的 应用锁定加压钢板(LCP)治疗桡骨远端粉碎性骨折并评估其疗效。方法 回顾性分析2002年8月～2003年8月使用LCP内固定术治疗的桡骨远端粉碎性骨折24例。结果 经过平均7．8个月的随访，优19例，良3例，差2例，优良率为91．67％。结论 虽然理论上LCP具有比普通钢板更高的力学稳定性，但是临床上的初步应用未显示突出的优越性。     

Hook plating in patella fractures

PurposeTension band wiring is considered the standard treatment for patella fractures. However, it is limited for fractures with marginal involvement, comminution, and osteoporotic bone. Our experience indicates that these limitations can be overcome with the hook plate. We evaluated the radiographic and clinical outcomes in patients with patella fracture treated with hook plating.MethodsWe enrolled 30 patients who underwent hook plating for patella fracture at two institutions between 2013 and 2017. Fracture classification and surgical options were reviewed. Postoperative fracture gap and time to union as radiographic measurements, and complications, range of motion, and functional outcome with the Lysholm score as clinical outcomes, were evaluated retrospectively.ResultsNine fractures were AO/OTA 34A1, three B1, one B2, two C1, nine C2, and six C3. All were closed fractures. There were 3 cases of revision, 4 with lateral or medial marginal fracture, 9 with isolated inferior pole fracture, and 14 with comminuted fracture. The average postoperative fracture gap was 0.4 (range, 0–2.0) mm, and bone union was achieved without additional intervention. The average time to union was 11.6 (range, 7–24) weeks. There were no complications, and no extension lag except in one case (10°). The average flexion was 138.5° (range, 110–145°). For functional outcomes, the average Lysholm score was 89.5 (range, 74–95), with 13 excellent, 14 good, 3 fair, and no poor cases.ConclusionThis study suggests that hook plating can result in good bone union and restored knee function in marginal or comminuted fractures of the patella.     

胫骨远端锁定加压钢板治疗Pilon骨折的疗效分析

目的 分析应用胫骨远端锁定加压钢板治疗粉碎性Pilon骨折的疗效。方法 胫骨远端锁定加压钢板治疗14例Pilon骨折患者,腓骨作外侧偏后纵切口,复位后用1／3管型或重建钢板固定。胫骨作有限切开复位后,用胫骨远端锁定加压钢板经皮下插入,锁定螺钉固定。结果 14例均获随访,时间7—24个月。采用Mazur评分系统评估手术疗效,优5例,良6例,可3例,无切口裂开和深部感染发生。结论 对粉碎性Pilon骨折选用胫骨远端锁定加压钢板内固定能获得优良疗效。     

A contoured locking plate for distal fibular fractures in osteoporotic bone: a biomechanical cadaver study

ObjectiveFixation of ankle fractures in elderly patients is associated with reduced stability conditioned by osteoporotic bone. Therefore, fixation with implants providing improved biomechanical features could allow a more functional treatment, diminish implant failure and avoid consequences of immobilisation.Materials and methodsIn the actual study, we evaluated a lateral conventional contoured plate with a locking contoured plate stabilising experimentally induced distal fibular fractures in human cadavers from elderly. Ankle fractures were induced by the supination-external rotation mechanism according to Lauge-Hansen. Stage II fractures (AO 44-B1) were fixed with the 2 contoured plates and a torque to failure test was performed. Bone mineral density (BMD) was measured by quantitative computed tomography to correlate the parameters of the biomechanical experiments with bone quality.ResultsThe locking plate showed a higher torque to failure, angle at failure, and maximal torque compared to the conventional plate. In contrast to the nonlocking system, fixation with the locking plate was independent of BMD.ConclusionFixation of distal fibular fractures in osteoporotic bone with the contoured locking plate may be advantageous as compared to the nonlocking contoured plate. The locking plate with improved biomechanical attributes may allow a more functional treatment, reduce complications and consequences of immobilisation.     

The primary arthrodesis for severely comminuted intra-articular fractures of the calcaneus: A systematic review

BackgroundAlthough open reduction and internal fixation via the extended lateral approach is currently considered gold-standard, severely comminuted calcaneal fractures might not be amendable for reconstruction. The primary aim of the current review study was to assess the functional outcome of the primary arthrodesis in the management of comminuted displaced intra-articular calcaneal fractures.MethodsThe literature was searched for studies published between January 1st 1990 and December 1st 2010, to identify studies in which a primary arthrodesis was utilized for the treatment of displaced intra-articular calcaneal fractures between. The methodological quality of the included studies was assessed using the Coleman Methodology Score.ResultsSeven case series and one abstract were identified, reporting on 120 patients with 128 severely comminuted calcaneal fractures. Average follow-up time was 28 months and union rate 97%. Functional outcome was assessed using the modified AOFAS score in seven studies; with a weighted average of 77.4 (range 72.4–88). One study reported a 75% good to excellent outcome on the Paley score. Three studies reported on return to work, ranging from 75 to 100%. Overall reported wound complications occurred in 19.4%. The average Coleman Methodology Score was 56 (range 38–68) points.ConclusionsThe primary arthrodesis for the treatment of Sanders type-IV comminuted displaced intra-articular calcaneal fractures provides overall good results considering the severe nature of the injury. Therefore, in the process of choosing the best treatment modality for a severely comminuted calcaneal fracture, the primary arthrodesis should receive full consideration.     

Application of pre-contoured anatomic locking plate for treatment of humerus split type greater tuberosity fractures: A prospective review of 68 cases with an average follow-up of 2.5 years

ObjectivesAlthough various implants exist for 3- and 4-part proximal humerus fractures, few implants are appropriate for humerus split type greater tuberosity fractures. The goal of this study was to assess the efficacy of pre-contoured anatomic locking plate for humerus split type greater tuberosity fractures.MethodsA retrospective review of 68 patients with humerus split type greater tuberosity fractures treated with open reduction and internal fixation using anatomic locking plates between January 2014 and October 2016. Postoperatively, patient radiographs, functional results, and complications were reviewed.ResultsAll patients got a mean follow-up of 30.5 months (range 14–46 months). Average fracture healing time was 9.4 weeks (range, 8–14 weeks). Overall mean Constant score was 86.8% (range, 70%–96%). The result was rated as excellent in 25 patients (Constant score: 92.1%), good in 38 patients (Constant score: 85.3%) moderate in 5 patients (Constant score: 71.8%) and poor in 0 cases. The excellent-good rate was 92.6%. No recurrence of dislocation occurred in the 30 cases with shoulder dislocation. All fractures healed without the complications of wound infection, subacromial impingement syndrome, nonunion, secondary displacement, and implant loosening.ConclusionPre-contoured anatomic locking plate is a reliable option in treating humerus split type greater tuberosity fractures as it provides stable fixation with an early return to function. The surgical technique is easy and efficient.     

Evaluation of results of open distal femur fractures with primary fixation and antibiotic impregnated collagen

Purpose: Distal femoral fracture is one of the most common lower limb injuries and accounts for less than 1% of all fractures. Open fracture takes 5%e10% of the all distal femoral fractures, which is at an increased risk of complications. There were limited studies which documented the outcomes of such cases. The present study aims to evaluate the outcome and complications in these fractures using primary definitive fixation with condylar locking plate and antibiotic impregnated collagen sheet secondary to aggressive debridement. Methods: This is a prospective study conducted in a tertiary care orthopaedic hospital in northern India. Thirty patients of open distal femoral fractures were managed by primary definitive fixation with condylar locking plate and antibiotic impregnated collagen sheet secondary to aggressive debridement. They were followed for minimum of six months. Patients were followed up monthly for first four months, at six months and one year after surgery. Clinical and radiological signs of healing, any complications, time to union, and functional outcome were assessed. Results: The mean age of patients was 44.33 years (range 20-82 years) with male predominance of 66.7%. According to Gustilo-Anderson classification, there were 5, 15 and 10 patients with open grade I, II and IIIA distal femoral fractures respectively. According to orthopaedic trauma association (OTA) classification, majority of patients in our study were of C3 type. The mean time to bony union was 5.6 months (range 4e9 months). Average postoperative knee range of motion (ROM) at the latest follow-up was 98? (range 70?-120?). Lysholm knee scoring scale showed excellent score in 11 patients, good in 9 patients, fair and poor in 5 patients each; however, there was no significant correlation with fracture pattern types (p < 0.05). Knee stiffness was the major complications encountered in the study. The knee ROM was <90? in 5 patients and 90?-120? in rest of the patients, while 1 patient had extensor lag of 10?. One patient had implant failure and lost to follow-up; 3 patients had deep infection. Conclusion: An approach of primary definitive fixation with condylar locking plate and antibiotic impregnated collagen sheet secondary to early aggressive debridement in open distal femur fractures shows significant results in terms of functional and radiological outcomes with minimal complications.     

Management of type IIB and IIIB olecranon fractures. Case series

Objectivesto report and evaluate the functional outcome of plate fixation in comminuted olecranon fractures (Mayo types IIB and IIIB).Method23 consecutive patients with comminuted fractures of the olecranon presenting to our unit Between Feb 2011 and Jan 2015, at a mean follow-up of thirty-six months. Main outcome measurements include radiographic healing, post-operative range of motion, complications, outcome score and patient satisfaction.ResultsOur study included thirteen females and ten males with a mean age of 55(18–97). Fourteen were Mayo type IIB and nine were Mayo type IIIB. Eighteen patients had no complications post-operatively with good outcome with mean oxford score of 45, full rotational ROM and mean flexion arc of 20–130 °. Five patients had range of motion between 40–90 ° with full rotational ROM and mean oxford score of 24. Two patients out of five required metal work removal. No non-unions were noted in our series.ConclusionPlate fixation of complex olecranon fracture is an effective, reliable method of treatment with low risk of non-union. Restoration of a functional flexion arc of movement can be expected with application of correct technique.     

解剖型钢板治疗粉碎性尺骨鹰嘴骨折

目的 探讨解剖型钢板治疗粉碎性尺骨鹰嘴骨折的疗效.方法 2002年2月至2007年7月,共52例移位粉碎性尺骨鹰嘴骨折的患者,男37例,女15例,平均年龄37.6岁.按照Mayo分型:其中ⅡB型31例,ⅢB型21例.所有骨折均行切开复位解剖型钢板内固定.结果 术后49例获得随访,随访时间为12～20个月,平均14.2个月.所有骨折均于3个月内愈合,无伤口感染;3例由于钢板皮下激惹,取出内固定后症状缓解.术后采用Broderg和Money评分标准进行评估:30例ⅡB型骨折中优22例,良6例,可2例,差0例,优良率为93.3%;19例ⅢB型骨折中优6例,良8例,可4例,差1例,优良率为73.7%.两组疗效差别有统计学意义(P<0.05).结论 解剖型钢板是治疗粉碎性尺骨鹰嘴骨折的安全有效的方法,Mayo分型可作为判断骨折预后的依据.     

桥接组合式内固定系统治疗股骨干粉碎性骨折在基层医院的应用

目的探讨桥接组合式内固定系统治疗股骨干粉碎性在骨折基层医院中的应用效果。方法回顾性分析2015年1月至2017年1月在我院采用桥接组合式骨折内固定系统和锁定钢板治疗股骨干粉碎性骨折各20例患者的临床资料,比较两组患者的术前时间、术中出血量、手术时间、住院时间、并发症、骨折愈合情况和肢体功能评价。结果桥接组合式骨折内固定系统术前时间、术中出血量、手术时间、住院时间、并发症、骨折愈合情况和肢体功能评价均优于锁定钢板组(P0.05),且无并发症出现。结论桥接组合式内固定系统操作简易、任意组合、应用广泛,适合基层医院的医疗水平以较好处理股骨干粉碎性骨折。     

Treating patella fractures with a fixed-angle patella plate—A prospective observational study

IntroductionAnterior tension wiring using Kirschner wires (K-wires) is still considered the standard treatment for patella fractures, despite its high complication rate. The objective of this prospective clinical study was to evaluate intra- and perioperative complications as well as the clinical outcome of patients with patella fracture treated with a new developed bilateral, polyaxial, fixed-angle 2.7 mm patella plate.Patients and methodsBetween 2011 and 2014 all patients with a patella fracture were included in this prospective study and treated with a fixed-angle patella plate. Avulsion fractures of the inferior or superior pole of the patella were excluded. All fractures were classified according to the AO/OTA fracture classification. During a twelve-month follow up period all intra- and postoperative complications were recorded as well as the time until fracture healing. One year postoperatively the Lysholm Score, the pre- and postoperative Tegner Score, the Hospital for Special Surgery Knee Score (HSS), the Turba Score, the Oxford Knee Score, the Knee injury and Osteoarthritis Outcome Score (KOOS), the Bostman Score and the Iowa Knee Score were surveyed. Altogether, 20 patella fractures in 19 patients were included in this prospective study. The most frequent type of fracture, n = 10, was a simple transverse patella fracture (C1), followed by 7 comminuted patella fractures (C3) and 3 T-shaped patella fractures (C2).ResultsDuring the 12-month follow up period two patients treated with the patella plate had a complication. In one patient a superficial wound infection occurred, which was treated successfully with hardware removal and in one patient a fracture dislocation due to an implant failure occurred. X-rays demonstrated complete bony healing in all fractures on average 3.2 months postoperatively. All knee scores showed good to excellent clinical results one year postoperatively.ConclusionThe results of this first clinical study indicate that the fixed-angle patella plate is an effective and safe treatment option for patella fractures with a short operative learning curve. The treatment of communited patella fractures (C3) with a fixed-angle patella plate should be well-considered to avoid distending the indication and biomechanical properties.     

Fibula pro-tibia vs standard locking plate fixation in an ankle fracture saw bone model

BACKGROUNDLocking plate fixation in osteoporotic ankle fractures may fail due to cut-out or metalwork failure. Fibula pro-tibia fixation was a technique prior to the advent of locking plates that was used to enhance stability in ankle fractures by achieving tri or tetra-cortical fixation. With locking plates, the strength of this fixation construct can be further enhanced. There is lack of evidence currently on the merits of tibia-pro-fibula augmented locking plate fixation of unstable ankle fractures.AIMTo assess if there is increased strength to failure, in an ankle fracture saw bone model, with a fibula pro-tibia construct when compared with standard locking plate fixation.METHODSTen osteoporotic saw bones with simulated supination external rotation injuries were used. Five saw bones were fixed with standard locking plates whilst the other 5 saw bones were fixed with locking plates in a fibula pro-tibia construct. The fibula pro-tibia construct involved fixation with 3 consecutive locking screws applied across 3 cortices proximally from the level of the syndesmosis. All fixations were tested in axial external rotation to failure on an electromagnetic test frame (MTS 858 Mini-Bionix test machine, MTS Corp, Eden Praire, MN, United States). Torque at 30 degrees external rotation, failure torque, and external rotation angle at failure were compared between both groups and statistically analyzed.RESULTSThe fibula pro-tibia construct demonstrated a statistically higher torque at 30 degrees external rotation (4.421 ± 0.796 N/m vs 1.451 ± 0.467 N/m; t-test P = 0.000), as well as maximum torque at failure (5.079 ± 0.694N/m vs 2.299 ± 0.931 N/m; t-test P = 0.001) compared to the standard locking plate construct. The fibula pro-tibia construct also had a lower external rotation angle at failure (54.7 ± 14.5 vs 67.7 ± 22.9).CONCLUSIONThe fibula pro-tibia locking plate construct demonstrates biomechanical superiority to standard locking plates in fixation of unstable ankle fractures in this saw bone model. There is merit in the use of this construct in patients with unstable osteoporotic ankle fractures as it may aid improved clinical outcomes.