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A comparison of outcomes of locking versus non-locking plate fixation for the distal fibula fractures: a systematic review and meta-analysis

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Abstract

Purpose

A locking plate (LP) or non-locking plate (NLP) can be used for distal fibula fracture fixation. However, the advantages of LP over NLP in patients with distal fibula fractures are not clear. In terms of indications, the role of the two plates probably differs; however, to draw comparative conclusions, we conceptualized this systematic review and meta-analysis of studies that directly compared the two plates, wherein both groups’ indications and baseline parameters were similar.

Methods

An electronic literature search was performed using PubMed/Medline, Embase, Scopus, and Cochrane Library databases for studies comparing the LP versus NLP fixation for the lateral malleolus fracture. A total of 18 studies were included in qualitative and quantitative analysis. A subgroup analysis was performed for patients aged < 55 years and patients aged > 55 years. The statistical analysis was performed by Review Manager Software version 5.4.1.

Results

A meta-analysis of 4243 fractures was performed across 18 studies. The rate of fracture union and overall complication rates did not differ between the two fixation groups with an OR of 0.71 (95% CI 0.26, 1.96, p = 0.51 and 1.11 (95% CI 0.84, 1.47, p = 0.47, respectively. There is no difference in the reoperation rate due to minor or major complications between the two groups. There was no difference in functional outcome (MD −0.85, with 95% CI −5.63, 3.93, p = 0.73), but NLP has a shorter surgical duration (MD 3.0, with 95% CI 0.26, 5.75, p = 0.03). A leave-one-out sensitivity analysis performed for overall complications affected the final outcome of the meta-analysis.

Conclusion

This meta-analysis demonstrates no clear benefit in selecting LP over NLP for the fixation of lateral malleolus fractures.

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References

  1. Court-Brown CM, Caesar B (2006) Epidemiology of adult fractures: a review. Injury 37(8):691–697. https://doi.org/10.1016/j.injury.2006.04.130

    Article  PubMed  Google Scholar 

  2. Dhillon MS, Rajnish RK, Patel S, Chouhan DK, Bansal T (2020) Osteoporotic ankle fractures: a narrative review of management options. J Clin Orthop Trauma 11(3):380–387. https://doi.org/10.1016/j.jcot.2019.10.010

    Article  PubMed  Google Scholar 

  3. Lamontagne J, Blachut PA, Broekhuyse HM, O’Brien PJ, Meek RN (2002) Surgical treatment of a displaced lateral malleolus fracture: the antiglide technique versus lateral plate fixation. J Orthop Trauma 16(7):498–502. https://doi.org/10.1097/00005131-200208000-00008

    Article  PubMed  Google Scholar 

  4. Krenk DE, Molinero KG, Mascarenhas L, Muffly MT, Altman GT (2009) Results of minimally invasive distal fibular plate osteosynthesis. J Trauma 66(2):570–575. https://doi.org/10.1097/TA.0b013e31818936ff

    Article  PubMed  Google Scholar 

  5. Mitchell JJ, Bailey JR, Bozzio AE, Fader RR, Mauffrey C (2014) Fixation of distal fibula fractures: an update. Foot Ankle Int 35(12):1367–1375. https://doi.org/10.1177/1071100714555712

    Article  PubMed  Google Scholar 

  6. Makwana NK, Bhowal B, Harper WM, Hui AW (2001) Conservative versus operative treatment for displaced ankle fractures in patients over 55 years of age. A prospective, randomised study. J Bone Joint Surg Br 83(4):525–529. https://doi.org/10.1302/0301-620x.83b4.11522

    Article  PubMed  CAS  Google Scholar 

  7. Phillips WA, Schwartz HS, Keller CS, Woodward HR, Rudd WS, Spiegel PG, Laros GS (1985) A prospective, randomized study of the management of severe ankle fractures. J Bone Joint Surg Am 67(1):67–78

    Article  PubMed  CAS  Google Scholar 

  8. Court-Brown CM, McBirnie J, Wilson G (1998) Adult ankle fractures–an increasing problem? Acta Orthop Scand 69(1):43–47. https://doi.org/10.3109/17453679809002355

    Article  PubMed  CAS  Google Scholar 

  9. Wagner M (2003) General principles for the clinical use of the LCP. Injury 34(Suppl 2):B31-42. https://doi.org/10.1016/j.injury.2003.09.023

    Article  PubMed  Google Scholar 

  10. Jöckel JA, Erhardt J, Vincenti M, Reissig J, Hoffmann R, Husain B et al (2013) Minimally invasive and open surgical treatment of proximal tibia fractures using a polyaxial locking plate system: a prospective multi-centre study. Int Orthop 37(4):701–708. https://doi.org/10.1007/s00264-013-1820-x

    Article  PubMed  PubMed Central  Google Scholar 

  11. Herrera-Pérez M, Gutiérrez-Morales MJ, Guerra-Ferraz A, Pais-Brito JL, Boluda-Mengod J, Garcés GL (2017) Locking versus non-locking one-third tubular plates for treating osteoporotic distal fibula fractures: a comparative study. Injury 48(Suppl 6):S60–S65. https://doi.org/10.1016/S0020-1383(17)30796-9

    Article  PubMed  Google Scholar 

  12. Jastifer JR (2014) Topical review: locking plate technology in foot and ankle surgery. Foot Ankle Int 35(5):512–518. https://doi.org/10.1177/1071100714523274

    Article  PubMed  Google Scholar 

  13. Schepers T, Van Lieshout EM, De Vries MR, Van der Elst M (2011) Increased rates of wound complications with locking plates in distal fibular fractures. Injury 42(10):1125–1129. https://doi.org/10.1016/j.injury.2011.01.009

    Article  PubMed  CAS  Google Scholar 

  14. Uhthoff HK, Poitras P, Backman DS (2006) Internal plate fixation of fractures: short history and recent developments. J Orthop Sci 11(2):118–126. https://doi.org/10.1007/s00776-005-0984-7

    Article  PubMed  PubMed Central  Google Scholar 

  15. Lynde MJ, Sautter T, Hamilton GA, Schuberth JM (2013) Complications after open reduction and internal fixation of ankle fractures in the elderly. Foot Ankle Surg 18(2):103–107. https://doi.org/10.1016/j.fas.2011.03.010

    Article  Google Scholar 

  16. Davis AT, Israel H, Cannada LK, Bledsoe JG (2013) A biomechanical comparison of one-third tubular plates versus periarticular plates for fixation of osteoporotic distal fibula fractures. J Orthop Trauma 27(9):e201–e207. https://doi.org/10.1097/BOT.0b013e318281a565

    Article  PubMed  Google Scholar 

  17. Zahn RK, Frey S, Jakubietz RG, Jakubietz MG, Doht S, Schneider P et al (2012) A contoured locking plate for distal fibular fractures in osteoporotic bone: a biomechanical cadaver study. Injury 43(6):718–725. https://doi.org/10.1016/j.injury.2011.07.009

    Article  PubMed  Google Scholar 

  18. Switaj PJ, Wetzel RJ, Jain NP, Weatherford BM, Ren Y, Zhang LQ et al (2016) Comparison of modern locked plating and antiglide plating for fixation of osteoporotic distal fibular fractures. Foot Ankle Surg 22(3):158–163. https://doi.org/10.1016/j.fas.2015.06.007

    Article  PubMed  Google Scholar 

  19. Nguyentat A, Camisa W, Patel S, Lagaay P (2016) A biomechanical comparison of locking versus conventional plate fixation for distal fibula fractures in trimalleolar ankle injuries. J Foot Ankle Surg 55(1):132–135. https://doi.org/10.1053/j.jfas.2015.08.017

    Article  PubMed  Google Scholar 

  20. Huang Z, Liu L, Tu C, Zhang H, Fang Y, Yang T et al (2014) Comparison of three plate system for lateral malleolar fixation. BMC Musculoskelet Disord 15:360. https://doi.org/10.1186/1471-2474-15-360

    Article  PubMed  PubMed Central  Google Scholar 

  21. Lyle SA, Malik C, Oddy MJ (2018) Comparison of locking versus nonlocking plates for distal fibula fractures. J Foot Ankle Surg 57(4):664–667. https://doi.org/10.1053/j.jfas.2017.11.035

    Article  PubMed  Google Scholar 

  22. Tsukada S, Otsuji M, Shiozaki A, Yamamoto A, Komatsu S, Yoshimura H et al (2013) Locking versus non-locking neutralization plates for treatment of lateral malleolar fractures: a randomized controlled trial. Int Orthop 37(12):2451–2456. https://doi.org/10.1007/s00264-013-2109-9

    Article  PubMed  PubMed Central  Google Scholar 

  23. Petruccelli R, Bisaccia M, Rinonapoli G, Rollo G, Meccariello L, Falzarano G et al (2017) Tubular vs profile plate in peroneal or bimalleolar fractures: is there a real difference in skin complication? a retrospective study in three level I trauma center. Med Arch 71(4):265–269. https://doi.org/10.5455/medarh.2017.71.265-269

    Article  PubMed  PubMed Central  Google Scholar 

  24. Moss LK, Kim-Orden MH, Ravinsky R, Hoshino CM, Zinar DM, Gold SM (2017) Implant failure rates and cost analysis of contoured locking versus conventional plate fixation of distal fibula fractures. Orthopedics 40(6):e1024–e1029. https://doi.org/10.3928/01477447-20171012-05

    Article  PubMed  Google Scholar 

  25. Moriarity A, Ellanti P, Mohan K, Fhoghlu CN, Fenelon C, McKenna J (2018) A comparison of complication rates between locking and non-locking plates in distal fibular fractures. Orthop Traumatol Surg Res 104(4):503–506. https://doi.org/10.1016/j.otsr.2018.03.001

    Article  PubMed  CAS  Google Scholar 

  26. Aigner R, Lechler P, Boese CK, Ruchholtz S, Frink M (2019) Operative treatment of geriatric ankle fractures with conventional or locking plates. A retrospective case-control study. Foot Ankle Surg 25(6):766–770. https://doi.org/10.1016/j.fas.2018.10.002

    Article  PubMed  Google Scholar 

  27. El Fatayri B, Bulaïd Y, Djebara AE, Havet E, Mertl P, Dehl M (2019) A comparison of bone union and complication rates between locking and non-locking plates in distal fibular fracture: retrospective study of 106 cases. Injury 50(12):2324–2331. https://doi.org/10.1016/j.injury.2019.10.001

    Article  PubMed  Google Scholar 

  28. Shih CA, Jou IM, Lee PY, Lu CL, Su WR, Yeh ML et al (2020) Treating AO/OTA 44B lateral malleolar fracture in patients over 50 years of age: periarticular locking plate versus non-locking plate. J Orthop Surg Res 15(1):112. https://doi.org/10.1186/s13018-020-01622-9

    Article  PubMed  PubMed Central  Google Scholar 

  29. Zyskowski M, Wurm M, Greve F, Pesch S, von Matthey F, Pflüger P et al (2021) Is early full weight bearing safe following locking plate ORIF of distal fibula fractures? BMC Musculoskelet Disord 22(1):159. https://doi.org/10.1186/s12891-021-04009-x

    Article  PubMed  PubMed Central  Google Scholar 

  30. Hasami NA, Smeeing DPJ, Pull Ter Gunne AF, Edwards MJR, Nelen SD (2022) Operative fixation of lateral malleolus fractures with locking plates vs nonlocking plates: a systematic review and meta-analysis. Foot Ankle Int 43(2):280–290. https://doi.org/10.1177/10711007211040508

    Article  PubMed  Google Scholar 

  31. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 372:n71. doi: https://doi.org/10.1136/bmj.n71

  32. Haddaway NR, Page MJ, Pritchard CC, McGuinness LA (2022) PRISMA 2020: an R package and Shiny app for producing PRISMA 2020-compliant flow diagrams, with interactivity for optimised digital transparency and open synthesis. Campbell Syst Rev 18:e1230. https://doi.org/10.1002/cl2.1230

    Article  PubMed  PubMed Central  Google Scholar 

  33. Review Manager (RevMan) [Computer program]. Version 5.4, (2020): The Cochrane Collaboration

  34. Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J (2003) Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 73(9):712–716. https://doi.org/10.1046/j.1445-2197.2003.02748.x

    Article  PubMed  Google Scholar 

  35. Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al. (2011) Cochrane bias methods group; Cochrane statistical methods group. The Cochrane collaboration's tool for assessing risk of bias in randomised trials. BMJ. 343:d5928. doi: https://doi.org/10.1136/bmj.d5928

  36. Gentile J, Taylor BC, Chan R, French B (2015) Clinical comparison of minifragment plates versus conventional semitubular plates for fixation of distal fibula fractures. HSS J 11(2):148–153. https://doi.org/10.1007/s11420-015-9431-2

    Article  PubMed  PubMed Central  Google Scholar 

  37. Ahn JH, Cho SH, Jeong M, Kim YC (2021) One-third tubular plate remains a clinically good option in Danis-Weber type B distal fibular fracture fixation. Orthop Surg 13(8):2301–2309. https://doi.org/10.1111/os.13160

    Article  PubMed  PubMed Central  Google Scholar 

  38. Jacobsen GH, Gude MH, Viberg B, Gundtoft PH (2022) Risk of reoperation in simple ankle fracture surgery when comparing locking plate with nonlocking plate. J Foot Ankle Surg 61(3):567–571. https://doi.org/10.1053/j.jfas.2021.10.008

    Article  PubMed  Google Scholar 

  39. Chang G, Bhat SB, Raikin SM, Kane JM, Kay A, Ahmad J et al (2018) Economic analysis of anatomic plating versus tubular plating for the treatment of fibula fractures. Orthopedics 41(2):e252–e256. https://doi.org/10.3928/01477447-20180213-01

    Article  PubMed  Google Scholar 

  40. Schagemann JC, Neumann H, Schäfers J, Paech A, Wendlandt R, Oheim R et al (2022) similar clinical outcome in locking and conventional plate osteosynthesis for the treatment of AO 44–B2 ankle fractures. Foot Ankle Spec 23:19386400221136756. https://doi.org/10.1177/19386400221136757

    Article  Google Scholar 

  41. Sop A, Kali M, Spindel JF, Brown SM, Samanta D (2023) Retrospective analysis of locked versus non-locked plating of distal fibula fractures. Injury 54(2):768–771. https://doi.org/10.1016/j.injury.2022.11.049

    Article  PubMed  Google Scholar 

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Author notes

  1. Rajesh Kumar Rajnish is the co-first author.

Authors and Affiliations

  1. Department of Orthopaedics, PGIMER, Chandigarh, India

    Mandeep Singh Dhillon, Prasoon Kumar & Siddhartha Sharma

  2. Department of Orthopaedics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India

    Rajesh Kumar Rajnish

  3. Department of Orthopaedics, All India Institute of Medical Sciences, Bathinda, India

    Gagan Preet Singh

  4. Department of Orthopaedics, University College of Medical Sciences and GTB Hospital, Delhi, India

    Amit Srivastava

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All the above-mentioned authors have made substantial contributions to all of the following: (1) the conception and design of the study, or acquisition of data, or analysis and interpretation of data, (2) drafting the article or revising it critically for important intellectual content, (3) final approval of the version to be submitted.

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Dhillon, M.S., Rajnish, R.K., Kumar, P. et al. A comparison of outcomes of locking versus non-locking plate fixation for the distal fibula fractures: a systematic review and meta-analysis. Eur J Orthop Surg Traumatol 34, 75–89 (2024). https://doi.org/10.1007/s00590-023-03694-9

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