Treating AO/OTA 44B lateral malleolar fracture in patients over 50 years of age: periarticular locking plate versus non-locking plate

Abstract

Background: The role of locking plate in lateral malleolar fracture fixation for the elderly remains unclear. The aim of our study is to compare radiological and functional outcomes in older patients (> 50 years) with AO/OTA 44B lateral malleolar fractures after locking plate (PLP) or one-third non-locking tubular plate (TP) lateral fixation. Methods: We retrospectively reviewed the medical records of 72 patients (PLP group, 34 patients; TP group, 38 patients; mean age, 61.9 ± 7.6 years; range, 51-80 years; follow-up, 1 year). Patients with open fractures, syndesmosis injuries, and a previous ankle trauma or surgery were excluded. Demographic data, union rate, complications, radiographic outcomes, visual analog scale (VAS) scores, and foot and ankle outcome scores (FAOSs) between the groups were recorded and compared. We also investigated the association of clinical features with pain and function. Statistically, the Fisher's exact test was used for categorical variables and the Mann-Whitney U test for the continuous variables. The final model for the multiple regression analysis was used to predict factors related to functional outcomes. Results: There were no significant between-group differences in demographic data, complication rates, immediately postoperative distal fibula lengths, ankle osteoarthritis (OA) grades, talar tilt angles (TTAs) ≥ 2°, or reduction accuracy. All fractures achieved union. The PLP group had significantly lower rates of distal screw loosening, fibula shortening > 2 mm, OA grade progression, and TTAs ≥ 2°, and better FAOSs and VAS scores than was the case for the TP group after 1 year of follow-up (all p < 0.05). The severity of OA, TTA ≥ 2°, and distal screw loosening were positively associated with VAS scores, and negatively associated with FAOSs. Conclusions: When treating AO/OTA 44B fractures in patients over 50 years of age, PLPs provided better VAS scores, FAOSs, and radiological outcomes, including less fibula shortening > 2 mm, less osteoarthritic (OA) ankle progression, less implant removal rate, and fewer TTAs ≥ 2°than was the case for TPs after a 1-year follow-up. Level of evidence: Therapeutic level III

Is early full weight bearing safe following locking plate ORIF of distal fibula fractures?

“…Regarding the FAOS, our study shows excellent results in the clinical control after 12 months comparable to those described by Shih et al [ 57 ].…”

Operative Fixation of Lateral Malleolus Fractures With Locking Plates vs Nonlocking Plates: A Systematic Review and Meta-analysis

“…Eleven studies were considered suitable for inclusion in this systematic review and meta-analysis. 4,7,8,11,12,17,20,21,25,26,28 Ten of the included studies were retrospective cohort studies. 4,7,8,11,12,17,20,21,25,26 One of the included studies was a randomized controlled trial.…”

“…Of all included studies, 4 (36%) measured the functional outcome of the ankle in patients. 4,11,12,26 Different functional outcome measure tools were used: Shih et al 26 used the Foot and Ankle Outcome Score (FAOS), Bilgetekin et al 4 and Herrera-Pérez et al 11 used the American Orthopaedic Foot & Ankle Society (AOFAS) score), and Huang et al 12 used both the Olerud Molander Score (OMS) and the AOFAS score. The follow-up time at which the AOFAS score had been measured was not reported by Bilgetekin et al 4 All other studies reported results on the long term (ie, after 6 months), Herrera-Pérez et al 11 was the only study that reported both short-term (ie, less than 6 months) and longterm scores (Table 2).…”

“…13 In the last decade, the increasing amount of literature on the use of locking plates in ankle fracture surgery suggests an increasing use of this type of plate osteosynthesis in daily practice. 1,2,4,7,8,11,12,17,20,21,23,25,26,28 Plate osteosynthesis can be carried out using conventional nonlocking plates, such as one-third tubular plates or dynamic compression plates, but plate osteosynthesis can also be carried out with a variety of later developed locking plates, such as locking compression plates or anatomical locking compression plates. Locking plates allow the opportunity to combine dynamic compression principles with internal fixation using locking screws.…”

Comparative analysis of the effects of AO mini-plate and Kirschner wire pinning in the metacarpal fractures

“…However, in clinical application, the application effect of the above 2 kinds of internal fixation treatment is still controversial. [ 3 , 4 ] Therefore, this study further compared and analyzed the application effect of AO mini-plate screw and KW fixation in the treatment of metacarpal fracture, which is reported as follows.…”