Biomechanical Study: Resistance Comparison of Posterior Antiglide Plate and Lateral Plate on Synthetic Bone Models Simulating Danis-Weber B Malleolar Fractures

Abstract

Objective The purpose of this study was to compare different positions of plates in lateral malleolar Danis-Weber B fractures on synthetic bone: a lateral plate and a posterior antiglide plate. Methods Short oblique fractures of distal fibula at the level of the syndesmosys were simulated with a fibular osteotomy in sixteen synthetic fibula bones (Synbone®). Eight fractures were fixed with lateral plating associated with an independent lag screw, and the other eight were fixed with posterior antiglide plating with a lag screw through the plate. A strain gage was installed at the center of each plate at the osteotomy site. Supination and external rotation forces were applied to each of the two groups at the bend. Results The lateral position plate group suffered more deformity in response to supination forces compared to the group with the posterior antiglide plate, but this result was not statistically significant. In the tests with external rotation forces, the posterior antiglide plating group had significantly higher resistance (p < 0.05). Conclusion When subjected to external rotation forces, osteosynthesis with posterior antiglide plate models simulating type B fractures of the lateral malleolus of the ankle is more resistant than that of the neutralization plate.

Outcomes Following Posterior and Posterolateral Plating of Distal Fibula Fractures

“…4 Furthermore, several biomechanical studies have demonstrated improved biomechanical stability and strength with posterior or posterolateral antiglide plates when compared with traditional lateral neutralization plates. 1,7,12 One concern of posterior and posterolateral plating of the fibula is whether the position of the plate causes peroneal tendon irritation resulting in hardware removal. Weber and Krause 9 retrospectively reviewed 70 patients who underwent posterolateral plating of their fibula and found that 43% (30/70) required hardware removal because of peroneal tendon irritation.…”

“…3 Posterior and posterolateral plating is biomechanically advantageous because it directly buttresses against this pull and allows superior distal fixation with bicortical screws. 4,7,8 However, despite its biomechanical superiority, some authors have concern for an increased risk of peroneal tendon injury with posterior and posterolateral plating when compared with lateral plating. No significant differences have been noted between different plating constructs in terms of common complications such as infection, wound dehiscence, hardware failure, or loss of reduction.…”

Treatment of B3 type fractures of shin bones associated with Volkmanns triangle fracture

“…Ïîçèö³îíóâàííÿ ïëàñòèíè ç ëàòåðàëüíî¿ ïî-âåðõí³ õàðàêòåðèçóºòüñÿ á³ëüøîþ äåôîðìàö³ºþ òà ìåíøîþ ñòàá³ëüí³ñòþ äî ñêðóòíèõ ñèë. Íàÿâíèé ðèçèê âíóòð³øíüîñóãëîáîâîãî ââåäåííÿ ãâèíòà ÿêèé âàaeêî ïðîêîíòðîëþâàòè çà äîïîìîãîþ ðåíò´åí-îïòè÷íîãî ïåðåòâîðþâà÷à [7]. Âíàñ-ë³äîê íåçíà÷íî¿ òîâùèíè ï³äøê³ðíî¿ aeèðîâî¿ êë³òêîâèíè íàä ëàòåðàëüíîþ ê³ñòî÷êîþ ó ïàö³-ºíò³â ñïîñòåð³ãàºòüñÿ äèñêîìôîðò ïðè íîñ³íí³ çâè÷àéíîãî âçóòòÿ [8] òà óñêëàäíåííÿ ç³ ñòîðîíè ï³ñëÿîïåðàö³éíî¿ ðàíè [7].…”

“…Íàÿâíèé ðèçèê âíóòð³øíüîñóãëîáîâîãî ââåäåííÿ ãâèíòà ÿêèé âàaeêî ïðîêîíòðîëþâàòè çà äîïîìîãîþ ðåíò´åí-îïòè÷íîãî ïåðåòâîðþâà÷à [7]. Âíàñ-ë³äîê íåçíà÷íî¿ òîâùèíè ï³äøê³ðíî¿ aeèðîâî¿ êë³òêîâèíè íàä ëàòåðàëüíîþ ê³ñòî÷êîþ ó ïàö³-ºíò³â ñïîñòåð³ãàºòüñÿ äèñêîìôîðò ïðè íîñ³íí³ çâè÷àéíîãî âçóòòÿ [8] òà óñêëàäíåííÿ ç³ ñòîðîíè ï³ñëÿîïåðàö³éíî¿ ðàíè [7]. Ïðè çàñòîñóâàíí³ çàäíüîãî äîñòóïó äàíå óñêëàäíåííÿ âèêëþ÷àºòüñÿ, ùî íàäຠìîaeëèâ³ñòü âèêîðèñòàííÿ á³êîðòèêàëüíèõ ãâèíò³â, ÿê³ çàáåçïå÷óþòü á³ëüøó ñòàá³ëü-í³ñòü [7].…”

“…Âíàñ-ë³äîê íåçíà÷íî¿ òîâùèíè ï³äøê³ðíî¿ aeèðîâî¿ êë³òêîâèíè íàä ëàòåðàëüíîþ ê³ñòî÷êîþ ó ïàö³-ºíò³â ñïîñòåð³ãàºòüñÿ äèñêîìôîðò ïðè íîñ³íí³ çâè÷àéíîãî âçóòòÿ [8] òà óñêëàäíåííÿ ç³ ñòîðîíè ï³ñëÿîïåðàö³éíî¿ ðàíè [7]. Ïðè çàñòîñóâàíí³ çàäíüîãî äîñòóïó äàíå óñêëàäíåííÿ âèêëþ÷àºòüñÿ, ùî íàäຠìîaeëèâ³ñòü âèêîðèñòàííÿ á³êîðòèêàëüíèõ ãâèíò³â, ÿê³ çàáåçïå÷óþòü á³ëüøó ñòàá³ëü-í³ñòü [7]. Íåîáõ³äí³ñòü îïåðàö³éíîãî ë³êóâàííÿ ïåðåëîì³â ëàòåðàëüíî¿ òà ìåä³àëüíî¿ ê³ñòî÷îê íà ñüîãîäí³ íå âèêëèêຠñóïåðå÷îê, õî÷à ïèòàííÿ ô³êñàö³¿ ïåðåëîì³â çàäíüîãî êðàþ âåëèêîãîì³ë-êîâî¿ ê³ñòêè çàëèøàºòüñÿ â³äêðèòèì.…”