Retrospective analysis of locked versus non-locked plating of distal fibula fractures |
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| Institution: | 1. Charleston Area Medical Center, Orthopedic Trauma Group, 3200 MacCorkle Avenue SE, Charleston, WV 25304, United States;2. Center for Health Services and Outcomes Research, Charleston Area Medical Center, United States;3. Gill Heart and Vascular Institute, University of Kentucky, Lexington, KY, United States;4. Madigan Army Medical Center. Lewis-McChord, WA, United States;1. University of Queensland, Brisbane, QLD, Australia;2. Mater Hospital, South Brisbane, QLD, Australia;1. Department of Orthopedic Surgery, University of Alberta, Edmonton, Alberta, Canada;2. Memorial University, Division of Orthopedic Surgery, Health Science Center, St. John''s, Newfoundland, Canada;3. University of Calgary, 0490 McCaig Tower, Foothills Hospital, 3134 Hospital Drive NW Calgary, Alberta, Canada T2N 5A1;1. Orthopaedic Surgeon, University of Toronto, St. Michael''s Hospital, Toronto, Ontario, Canada;2. The Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Suite J129, Ottawa, Ontario, Canada;3. University of Calgary, 0490 McCaig Tower, Foothills Hospital, 3134 Hospital Drive NW Calgary, Alberta T2N 5A1, Canada;1. Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rio de Janeiro, RJ, Brazil;2. St. Joseph University, Dept. of Orthopedic Surgery, Hotel Dieu de France Hospital, Alfred Naccache Blvd, Beirut, Lebanon;3. University of Calgary, 0490 McCaig Tower, Foothills Hospital, 3134 Hospital Drive NW Calgary, Alberta T2N 5A1, Canada;1. Department of Orthopedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India;2. Department of Translational & Regenerative Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India;3. Department of Orthopedics, All India Institute of Medical Sciences, Jodhpur, India;1. Department of Orthopedics, Third People''s Hospital of Hubei Province, Wuhan 430000, China;2. Department of Orthopedic Trauma, Wuhan Fourth Hospital, Wuhan 430000, China |
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| Abstract: | IntroductionUnstable distal fibular fractures have traditionally been treated with open reduction internal fixation using a 1/3 tubular non-locked plate (compression plating). Locked plating is a newer technique that has become more popular despite the lack of clinical data supporting improved outcomes. The cost of locked plating is almost four times that of compression plating. We compared rates of reoperation due to implant failure, infection, and symptomatic device between compression and locked plating in open reduction internal fixation of distal fibular fracturesMethodsA retrospective study was performed at a level one trauma center over a ten-year period (2008-2017). Patients who were 18 and older and treated for unstable ankle fractures with locking or non-locking plate were included in this study. Patient charts were reviewed by orthopedic trauma surgeons to identify whether patients were treated with a 1/3 tubular non-locking or pre-contoured locked plate and to determine the cause of reoperation.ResultsIn total, 442 patients were identified with 203 in the non-locked 1/3 tubular plate group and 239 in the pre-contoured locked plate group. A total of 38 patients (8.6%) underwent device removal with a higher proportion of patients in the non-locked 1/3 tubular plate cohort (11.3% vs. 6.3%, p = 0.059). Statistically significant differences in reasons for reoperation were found for symptomatic implant (78.3% vs. 46.7%, p = 0.045) and infection (8.7% vs 53.3%., p < 0.01). Of patients who had device removal for symptomatic implant in the compression plating cohort, 13 (72.2%) had lateral positioning and 5 (27.8%) had posterior positioning (p < 0.01) whereas there was no statistical difference in plate positioning in the locked cohort. Of all medical comorbidities identified, only diabetes was associated with a higher rate of infection-related reoperations (83.3% vs. 15.6%, p < 0.01).ConclusionsBoth compression and locked plate techniques demonstrated low reoperation rates. Compression plating with 1/3 tubular plates placed laterally more often resulted in reoperation due to symptomatic implant but had fewer complications of infection. Given that the cost is significantly less, 1/3 tubular plating placed posteriorly may be preferred to decrease the risks of symptomatic implant and infection. |
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