Posterior Antiglide Plating vs Lateral Neutralization Plating for Weber B Distal Fibular Fractures: A Systematic Review and Meta-analysis of Clinical and Biomechanical Studies

Abstract

Background: Distal fibular fractures are extremely common, yet there remains controversy about which type of plating technique is the most appropriate. We aimed to compare clinical and biomechanical outcomes following posterior antiglide plating and lateral neutralization plating for Weber B distal fibular fractures. Methods: A systematic review and meta-analysis of the literature was conducted by two independent reviewers according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We included all comparative studies of distal fibular fracture fixation with either a posterior antiglide plate or a lateral neutralization plate. Our primary outcome of interest was reoperation for hardware removal. Secondary outcomes included hardware discomfort, peroneal tendon irritation, infection, wound complications, and mechanical torque to failure. Results: A total of 1122 patients with Weber B ankle fractures were included across nine eligible clinical studies, and 76 cadaveric ankles were subject to testing across three eligible biomechanical studies. Meta-analyses revealed a two-fold greater odds of requiring removal of hardware in the lateral plating group compared to the posterior plating group (odds ratio [OR] 2.48, 95% CI 1.58 to 3.91, P < .0001), and a three-fold greater odds of experiencing hardware discomfort in the lateral plating group compared to the posterior plating group (OR 2.96, 95% CI 1.83 to 4.80, P < .0001). There were no significant differences in rates of peroneal tendon irritation, infection, wound complications, operative time, and torque to failure when comparing the two plating methods. Conclusion: The results of this review indicate that using posterior antiglide plating for distal fibular Weber B–type fractures is associated with significantly fewer reoperations due to hardware complications and less hardware discomfort compared to lateral neutralization plating. This technique does not appear to increase the risk of peroneal tendon irritation or increase operative time.

Complications following surgical treatment of ankle fractures in the elderly: can they be avoided?

“…Considering better soft tissue cover of implants, a posterolateral approach can be used for posterior malleolus fractures 25, , 21 as it allows simultaneous access to the fibular fracture, while antiglide plating of distal fibula appears to result in fewer hardware removal and reoperations than lateral plate positioning. 22,23 Bariteau et al 24 found that locking implants in lateral position provide greater stability in comminuted fractures. However, other authors take a critical view, 25,26 indicate higher costs and risk of wound complications.…”

What’s New in Orthopaedic Trauma

“…The rates of peroneal tendon irritation, infection, and wound complications, operative time, and torque to failure did not differ. However, patients experienced greater odds of implant discomfort (OR, 2.96 [95% CI, 1.83 to 4.80]; p < 0.0001) and implant removal (OR, 2.48 [95% CI, 1.58 to 3.91]; p < 0.0001) after lateral plating compared with posterior plating 19 .…”

Three-dimensional morphological study of type B lateral malleolar fractures with special reference to the end-tip location of proximal apexes

“…According to the applied position and biomechanical function, plates are used in a lateral neutralization mode or posterolateral antiglide mode. Biomechanical studies have shown that posterolateral antiglide plate fixation has more robust mechanical stability ( Schaffer and Manoli, 1987 ; Minihane et al, 2006 ; Buscharino et al, 2013 ; Deng et al, 2022 ). The posterolateral antiglide plate also has the advantages of less skin irritation, fewer wound complications, and a lower reoperation rate ( Winkler et al, 1990 ; Kilian et al, 2017 ; Wenger et al, 2021 ).…”