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. 2021 Nov 18;56(4):573-579.
doi: 10.1007/s43465-021-00562-8. eCollection 2022 Apr.

Mini-Blade Plate to Obtain Length Across Lateral Malleolus Fractures: Surgical Technique and Biomechanical Evaluation

Assaf Kadar  1   2 , Steven M Tommasini  1 , Amit Singla  1 , Brian G Beitler  1 , Alexander M Moushey  1 , Michael R Baumgaertner  1
Affiliations

Mini-Blade Plate to Obtain Length Across Lateral Malleolus Fractures: Surgical Technique and Biomechanical Evaluation

Assaf Kadar et al. Indian J Orthop. .

Abstract

Background: Restoration of fibular length is the main determinant in preventing mal-union and early ankle arthritis in lateral malleolus fractures. A 1/3 tubular plate fashioned into a mini-blade plate can be used to distract the distal fragment and achieve length in a controlled fashion over time. The purpose of this study was to describe the surgical technique and perform a biomechanical comparison of the blade plate to a locking plate.

Methods: A 1/3 tubular plate is fashioned into a 135° blade plate. Blades are seated into the lateral malleolus and a distally directed force is applied on the plate to obtain length.A lateral malleolus fracture was created in 20 cadaveric ankles. The distal fragment was fixed with either a blade plate (BP, n = 10) or a locking plate (LP, n = 10). A distally directed force was applied by an Instron machine and fracture distraction, maximal load and construct stiffness were measured and compared.

Results: The average maximal load was 262.06 N compared to 255.52 N for the BP and LP groups, respectively. The maximal distraction was 3.57 mm compared to 4.57 mm for the BP and LP groups, respectively. The loading pattern of the blade plate over time differed from that of a locking plate as the blades seat into bone.

Conclusion: A 1/3 tubular mini-blade plate demonstrates biomechanical similarities in terms of load and distraction to the more expensive locking plate. We recommend using this technique for fractures with late presentation or with significant shortening.

Level of evidence: Level V-Mechanism-based reasoning.

Keywords: Biomechanical; Blade plate; Lateral malleolus; Locking plate; Push–pull.

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Conflict of interest statement

Conflict of interestAll authors of this article have no financial or other conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Surgical technique for application of blade plate for lateral malleolus fractures
Fig. 2
Fig. 2
Cadaveric ankle with a locking plate (A) or a blade plate (B) fixing a lateral malleolus fracture
Fig. 3
Fig. 3
Specimen preparation and set up on the Instron system. Locking plate (left image) or blade plate (right image) were fixed to the lateral surface of the distal fibular fragment (A). The specimen was mounted on an Instron system, and a distally directed translational force was applied to the plate (B)
Fig. 4
Fig. 4
Fracture distraction at 0 s compared to 120 s for locking plate (A, B) and blade plate (C, D)
Fig. 5
Fig. 5
Mean distraction across lateral malleolus fractures (with standard error bars) over time of the blade plate compared to the locking plate group (A). Typical loading pattern of a blade plate compared to a locking plate over time. Note that the locking plate gains load gradually and linearly over time, while the blade plate demonstrated load drops as the plate is seated deeper into bone (B)
See this image and copyright information in PMC

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