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. 2023 Mar;143(3):1499-1504.
doi: 10.1007/s00402-022-04397-2. Epub 2022 Feb 28.

Minifragment plating of the fibula in unstable ankle fractures

D Penning  1 , C A L Jonker  1 , R Buijsman  2 , J A Halm  1 , T Schepers  3
Affiliations

Minifragment plating of the fibula in unstable ankle fractures

D Penning et al. Arch Orthop Trauma Surg. 2023 Mar.

Abstract

Introduction: Only 6.4-17% of the load is transmitted through the fibula when weight-bearing. Plate fixation of distal fibular fractures using minifragments (≤ 2.8 mm) could lead to similar reduction with less implant removal (IR) rates, compared to small-fragment plates (3.5 mm). We hypothesized that the use of minifragment plates is at least similar in unscheduled secondary surgery.

Materials and methods: In this retrospective cohort study, all patients with surgically treated distal fibular fractures between October 2015 and March 2021 were included. Patients treated with plate fixation using minifragments and patients treated with small-fragment plates were compared regarding the following outcomes: secondary dislocation, malreduction, implant malposition, nonunion, surgical site infections (SSI) and IR.

Results: Sixty-five patients (54.2%) received a minifragment implant (≤ 2.8 mm) and 55 patients (45.8%) received a small-fragment implant (3.5 mm). There were no patients needing secondary surgery in the minifragment group compared to 9 patients following fixation using small-fragment implants (3 with secondary dislocation, 5 with malreduction and 1 with malposition, p = 0.001). SSI rates were 3.1% for minifragment and 9.1% for small-fragment implants (p = 0.161). Implant removal was performed significantly less often following use of minifragment implants (17.8% and 53.2%, p < 0.001).

Conclusions: In this cohort, minifragment plate fixation for distal fibular fractures is an adequate fixation method offering stable fixation with significant lower need for implant removal and comparable complications to small-fragment plates, although an adequately powered randomized controlled study is needed for implementation in a clinical setting.

Level of evidence: Therapeutic, III.

Keywords: Ankle fracture; Distal fibula fracture; Fibula; Minifragment; Small fragment.

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Conflict of interest statement

All of the authors declare to have no conflict of interest.

Figures

Fig. 1
Fig. 1
Postoperative image of distal fibular fixation using small fragment with anteroposterior view (left) and lateral view (right)
Fig. 2
Fig. 2
Postoperative image of distal fibular fixation using minifragment with anteroposterior view (left) and lateral view (right)
See this image and copyright information in PMC

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