Comparative effectiveness of nitinol staple-only fixation versus antiglide plate fixation for Weber type B distal fibular fractures

Abstract

Background: Interest in less invasive surgeries for Weber type B distal fibular fracture has increased recently. This study aimed to demonstrate that nitinol staple-only fixation is less invasive compared to antiglide plate fixation.

Materials and methods: This retrospective review involved 59 patients with Weber type B fibular fractures who underwent surgery between 2018 and 2023. Twenty-eight patients underwent antiglide plate fixation, whereas 31 underwent multiple nitinol staple-only fixation. The intraoperative assessment included skin incision length and operative time. The radiographic outcomes were bone union and fibular length. The clinical outcomes included delayed wound healing, infection, discomfort from the implant, implant removal, and the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) score administered at the last visit.

Results: The mean skin incision length and operative time of nitinol staple-only fixation were 3.8 ± 0.5 cm and 19.6 ± 3.6 min, compared with 8.7 ± 1.3 cm and 48.8 ± 10.6 min for plate fixation, respectively. Bone union was confirmed in all patients without fibular shortening. Although no significant differences in patients with delayed wound healing, infection, or postoperative SAFE-Q scores were found between the two groups, more patients with plate fixation reported discomfort from the implant (71.4% vs. 32.3%) and requested its removal (75.0% vs. 35.5%).

Conclusion: Multiple nitinol staple-only fixations offer the advantages of a smaller skin incision, shorter operative time, lesser discomfort from the implants, and a reduced need for implant removal compared with antiglide plate fixation. Furthermore, staple-only fixation could achieve bone union without loss of correction. This suggests that multiple nitinol staple-only fixation may be less invasive and more beneficial for patients than antiglide plate fixation.

Keywords: Ankle fracture; Antiglide plates; Fibula fracture; Fracture fixation; Nitinol staples.

Fig. 1

Preoperative and postoperative anteroposterior and lateral radiographs of a patient who underwent antiglide plate fixation

Fig. 2

Fixation technique using nitinol staples. The initial 3-cm skin incision (A). The fracture was reduced using a bone clamp forceps (B) and fixed by placing the nitinol staple at the center, perpendicular to the fracture line after drilling (C and D). The bone clamp forceps were removed after fixation with a single staple, and two additional staples were placed in posterior and anterior fracture sites (E)

Fig. 3

Preoperative and postoperative anteroposterior and lateral radiographs of a patient who underwent fixation with multiple nitinol staples

Fig. 4

The fibular length is defined as the distance from the fibular tip to the tibial articular surface