DUAL PLATING FIXATION FOR DISTAL FIBULAR COMMINUTED FRACTURES_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

GUWenqi ,  SHIZhongmin , MEIGuohua , XUEJianfeng , ZOUJian

Department of Orthopaedics, Shanghai Sixth People's Hospital, Shanghai Jiaotong University, Shanghai, 200233, P. R. China;

Corresponding author：

SHIZhongmin, Email: shi.zhongmin@gmail.com

Keywords：

Distal fibular comminuted fracture; Dual plating; Internal fixation

DOI：

10.7507/1002-1892.20140013

Video：

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Objective To evaluate the technique and effectiveness of dual plating fixation for distal fibular comminuted fractures. Methods Between November 2010 and November 2011, 16 patients with distal fibular comminuted fractures were treated, including 10 males and 6 females with an average age of 49.8 years (range, 35-65 years). All the patients had closed injury, which was caused by sprain in 9 cases, by traffic accident in 5 cases, and by falling in 2 cases. The average interval from injury to admission was 8 hours (range, 1-48 hours). Routine X-ray and CT scan were taken for confirmation of classification and involvement. According to Weber classification system, 11 cases were rated as type A, and 5 as type B; 5 cases had bimalleolar fractures with medial malleolar fracture, and 2 cases had trimalleolar fractures with posterior and medial malleolar fracture. Open reduction and dual plating fixation were performed after swelling was subsided. The X-ray films were taken during follow-up. The effectiveness was evaluated with visual analogue scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot and ankle score system at last follow-up. The range of motion (ROM) of the ankle and complications were also been recorded. Results Delayed healing of incision occurred in 1 patient with diabetes, who was cured after changing dressing; primary healing was obtained in the other patients. Twelve patients were followed up 18 months on average (range, 12-24 months). Radiographic examination demonstrated the mean time of bone healing was 12 weeks (range, 10-14 weeks). No complication of implant failure, malunion, nonunion, or post-traumatic arthritis occurred during follow-up. The AOFAS hindfoot and ankle score was 79.6±6.5, and the VAS score was 1.3±1.5. The ROM of the ankle was (70.0±8.0)° of flexion and (84.0±5.1)° of extension. Conclusion Dual plating fixation for distal fibular comminuted fractures can obtain a rigid stabilization with a low complication incidence, so it is a safe and effective method.

Citation： GUWenqi, SHIZhongmin, MEIGuohua, XUEJianfeng, ZOUJian. DUAL PLATING FIXATION FOR DISTAL FIBULAR COMMINUTED FRACTURES. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(1): 56-59. doi: 10.7507/1002-1892.20140013 Copy

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2.	蒋协远,王大伟.骨科临床疗效评价标准.北京:人民卫生出版社,2005:123-124,231-232.
3.	Cole PA,Craft JA.Treatment of osteoporotic ankle fractures in the elderly:surgical strategies.Orthopedics,2002,25(4):427-430.
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6.	Tsukada S,Otsuji M, Shiozaki A,et al.Locking versus non-locking neutralization plates for treatment of lateral malleolar fractures:a randomized controlled trial.Int Orthop,2013.[Epub ahead of print].
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8.	White NJ,Corr DT,Wagg JP,et al.Locked plate fixation of the comminuted distal fibula:a biomechanical study.Can J Surg,2013,56(1):35-40.
9.	Eckel TT, Glisson RR, Anand P,et al.Biomechanical comparison of 4 different lateral plate constructs for distal fibula fractures.Foot Ankle Int,2013,34(11):1588-1595.
10.	Davis AT,Israel H,Cannada LK,et al.A biomechanical comparison of one-third tubular plates versus periarticular plates for fixation of osteoporotic distal fibula fractures.J Orthop Trauma,2013,27(9):e201-207.
11.	Minihane KP,Lee C,Ahn C,et al.Comparison of lateral locking plate and antiglide plate for fixation of distal fibular fractures in osteoporotic bone:a biomechanical study.J Orthop Trauma,2006,20(6):562-566.
12.	Zahn RK,Frey S,Jakubietz RG,et al.A contoured locking plate for distal fibular fractures in osteoporotic bone:a biomechanical cadaver study.Injury,2012,43(6):718-725.
13.	Kim T,Ayturk UM,Haskell A,et al.Fixation of osteoporotic distal fibula fractures:A biomechanical comparison of locking versus conventional plates.J Foot Ankle Surg,2007,46(1):2-6.
14.	Schepers T,Van Lieshout EM,De Vries MR,et al.Increased rates of wound complications with locking plates in distal fibular fractures.Injury,2011,42(10):1125-1129.
15.	Rochet S,Obert L,Lepage D,et al.Proximal ulna comminuted fractures:fixation using a double-plating technique.Orthop Traumatol Surg Res,2010,96(7):734-740.
16.	SooHoo NF,Krenek L,Eagan MJ,et al.Complication rates following open reduction and internal fixation of ankle fractures.J Bone Joint Surg (Am), 2009,91(5):1042-1049.
17.	Khurana S,Karia R,Egol KA.Operative treatment of nonunion following distal fibula and medial malleolar ankle fractures.Foot Ankle Int,2013,34(3):365-371.
18.	Chu A,Weiner L.Distal fibula malunions.J Am Acad Orthop Surg,2009,17(4):220-230.
19.	Halm JA,Schepers T.Damage to the superficial peroneal nerve in operative treatment of fibula fractures:straight to the bone? Case report and review of the literature.J Foot Ankle Surg,2012,51(5):684-686.

1. Strauss EJ,Egol KA.The management of ankle fractures in the elderly.Injury,2007,38 Suppl 3:S2-9.
2. 蒋协远,王大伟.骨科临床疗效评价标准.北京:人民卫生出版社,2005:123-124,231-232.
3. Cole PA,Craft JA.Treatment of osteoporotic ankle fractures in the elderly:surgical strategies.Orthopedics,2002,25(4):427-430.
4. Sanhudo JA.Technique tip:interfragmentary compression with mini screws for comminuted distal fibular fractures.Foot Ankle Int,2007,28(3):392.
5. Zhenhua F,Waizy H,Ming X,et al.Lateral malleolus hook plate for comminuted Weber A and B fractures:A retrospective study.Indian J Orthop,2013,47(4):364-369.
6. Tsukada S,Otsuji M, Shiozaki A,et al.Locking versus non-locking neutralization plates for treatment of lateral malleolar fractures:a randomized controlled trial.Int Orthop,2013.[Epub ahead of print].
7. Işik Ç,Tecimel O,Akmeşe R,et al.The comparison of plate-screw and tension band techniques in the osteosynthesis of Danis-Weber Type A and B lateral malleolar fractures.Acta Orthop Traumatol Turc,2013,47(1):27-31.
8. White NJ,Corr DT,Wagg JP,et al.Locked plate fixation of the comminuted distal fibula:a biomechanical study.Can J Surg,2013,56(1):35-40.
9. Eckel TT, Glisson RR, Anand P,et al.Biomechanical comparison of 4 different lateral plate constructs for distal fibula fractures.Foot Ankle Int,2013,34(11):1588-1595.
10. Davis AT,Israel H,Cannada LK,et al.A biomechanical comparison of one-third tubular plates versus periarticular plates for fixation of osteoporotic distal fibula fractures.J Orthop Trauma,2013,27(9):e201-207.
11. Minihane KP,Lee C,Ahn C,et al.Comparison of lateral locking plate and antiglide plate for fixation of distal fibular fractures in osteoporotic bone:a biomechanical study.J Orthop Trauma,2006,20(6):562-566.
12. Zahn RK,Frey S,Jakubietz RG,et al.A contoured locking plate for distal fibular fractures in osteoporotic bone:a biomechanical cadaver study.Injury,2012,43(6):718-725.
13. Kim T,Ayturk UM,Haskell A,et al.Fixation of osteoporotic distal fibula fractures:A biomechanical comparison of locking versus conventional plates.J Foot Ankle Surg,2007,46(1):2-6.
14. Schepers T,Van Lieshout EM,De Vries MR,et al.Increased rates of wound complications with locking plates in distal fibular fractures.Injury,2011,42(10):1125-1129.
15. Rochet S,Obert L,Lepage D,et al.Proximal ulna comminuted fractures:fixation using a double-plating technique.Orthop Traumatol Surg Res,2010,96(7):734-740.
16. SooHoo NF,Krenek L,Eagan MJ,et al.Complication rates following open reduction and internal fixation of ankle fractures.J Bone Joint Surg (Am), 2009,91(5):1042-1049.
17. Khurana S,Karia R,Egol KA.Operative treatment of nonunion following distal fibula and medial malleolar ankle fractures.Foot Ankle Int,2013,34(3):365-371.
18. Chu A,Weiner L.Distal fibula malunions.J Am Acad Orthop Surg,2009,17(4):220-230.
19. Halm JA,Schepers T.Damage to the superficial peroneal nerve in operative treatment of fibula fractures:straight to the bone? Case report and review of the literature.J Foot Ankle Surg,2012,51(5):684-686.

Chinese Journal of Reparative and Reconstructive Surgery

DUAL PLATING FIXATION FOR DISTAL FIBULAR COMMINUTED FRACTURES

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