A Biomechanical Comparison of One-Third Tubular Plates Versus Periarticular Plates for Fixation of Osteoporotic Distal Fibula Fractures

Abstract

In biomechanical testing using an osteoporotic model of OTA 44-B2.1 fractures, periarticular plates were superior to one-third tubular plates in rotational stiffness only. Locking plates did not outperform their nonlocking counterparts. Periarticular plates should be considered when treating osteoporotic distal fibula fractures, but one-third tubular plates and nonlocking plates provide adequate fixation for these injuries.

Clinical Comparison of Minifragment Plates Versus Conventional Semitubular Plates for Fixation of Distal Fibula Fractures

“…In an osteoporotic cadaveric model, a locking plate with two distal fibula locking screws was mechanically equivalent to a nonlocking plate with three distal cancellous screws [8]. Another recent investigation compared precontoured distal fibula plates to conventional one-third tubular plates and observed superior rotational stiffness with the precontoured plates [5]. However, the majority of these plates tend to be more bulky than the conventional semitubular plates and therefore do not eliminate the problem of hardware irritation.…”

Topical Review

“…Several biomechanical and clinical studies have directly compared locking and nonlocking plates in distal fibular fractures. 19,50,54,73 Davis et al 19 performed a biomechanical study in an osteoporotic Weber B fracture model comparing 4 groups: locking and nonlocking one-third tubular plates, and locking and nonlocking precontoured periarticular plates. The investigators showed that nonlocking plates had greater torque to failure and that the locking plates and the periarticular plates had greater rotational stiffness compared with the one-third tubular plates.…”

“…25,44,62,[64][65][66] This is tempered by other studies that have failed to consistently support the superiority of these fixed angle constructs. 19,27,32,50,74 This review examines the current use of locking plate technology in foot and ankle surgery and the evidence in support of this concept.…”

Necessity of Interfragmentary Lag Screws in Precontoured Lateral Locking Plate Fixation for Supination-External Rotation Lateral Malleolar Fractures

“…In comparison with conventional plates, locking plates are known to provide less periosteal compression and potentially more stable fixation in osteoporotic bone. 2,5,12,30,34 In clinical studies, the advantage of locking neutralization plates has not been clearly revealed vs conventional plates in lateral malleolar fractures, 29 but anatomically precontoured locking plates have shown better results than conventional ones in the absence of a lag screw. 8 For this reason, despite its increased cost, the interest in precontoured locking plates has been increasing.…”