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

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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.

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References

  1. Court-Brown, C. M., McBirnie, J., & Wilson, G. (1998). Adult ankle fractures—An increasing problem? Acta Orthopaedica Scandinavica, 69(1), 43–47.

    Article  CAS  Google Scholar 

  2. Kannus, P., Palvanen, M., Niemi, S., Parkkari, J., & Jrvinen, M. (2002). Increasing number and incidence of low-trauma ankle fractures in elderly people: Finnish statistics during 1970–2000 and projections for the future. Bone, 31(3), 430–433.

    Article  CAS  Google Scholar 

  3. Davidovitch, R., & Egol, K. (2010). Ankle fractures. In R. W. Bucholz, C. M. Court-Brown, J. D. Heckman, & P. Tornetta III. (Eds.), Rockwood and Green’s fractures in adults (7th ed., pp. 1974–2021). Philadelphia: Lippincott Williams & Wilkins.

    Google Scholar 

  4. Marti, R., Raaymakers, E., & Nolte, P. (1990). Malunited ankle fractures. The late results of reconstruction. The Journal of Bone and Joint Surgery British, 72(4), 709–713.

    Article  CAS  Google Scholar 

  5. Wukich, D. K., & Kline, A. J. (2008). The management of ankle fractures in patients with diabetes. JBJS, 90(7), 1570–1578.

    Article  Google Scholar 

  6. Yablon, I. G., & Leach, R. (1989). Reconstruction of malunited fractures of the lateral malleolus. The Journal of Bone and Joint Surgery American, 71(4), 521–527.

    Article  CAS  Google Scholar 

  7. Sutter, P.-M., & Peltzer, J. (2010). Principles of operative treatment of malleolar fractures today. European Journal of Trauma and Emergency Surgery, 36(6), 505–514.

    Article  Google Scholar 

  8. Lloyd, J., Elsayed, S., Hariharan, K., & Tanaka, H. (2006). Revisiting the concept of talar shift in ankle fractures. Foot & Ankle International, 27(10), 793–796.

    Article  Google Scholar 

  9. Aiyer, A. A., Zachwieja, E. C., Lawrie, C. M., & Kaplan, J. R. (2019). Management of isolated lateral malleolus fractures. JAAOS-Journal of the American Academy of Orthopaedic Surgeons, 27(2), 50–59.

    Article  Google Scholar 

  10. Weber, D., Friederich, N., & Müller, W. (1998). Lengthening osteotomy of the fibula for post-traumatic malunion. International Orthopaedics, 22(3), 149–152.

    Article  CAS  Google Scholar 

  11. Gerber, C., Mast, J., & Ganz, R. (1990). Biological internal fixation of fractures. Archives of Orthopaedic and Trauma Surgery, 109(6), 295–303.

    Article  CAS  Google Scholar 

  12. Bielska, I. A., Wang, X., Lee, R., & Johnson, A. P. (2019). The health economics of ankle and foot sprains and fractures: A systematic review of English-language published papers. Part 2: The direct and indirect costs of injury. The Foot, 39, 115–121.

    Article  Google Scholar 

  13. Davis, A. T., Israel, H., Cannada, L. K., & Bledsoe, J. G. (2013). A biomechanical comparison of one-third tubular plates versus periarticular plates for fixation of osteoporotic distal fibula fractures. Journal of Orthopaedic Trauma, 27(9), e201–e207.

    Article  Google Scholar 

  14. Lee, Y.-S., Huang, C.-C., Chen, C.-N., & Lin, C.-C. (2005). Operative treatment of displaced lateral malleolar fractures: The Knowles pin technique. Journal of Orthopaedic Trauma, 19(3), 192–197.

    Article  Google Scholar 

  15. Milner, B. F., Mercer, D., Firoozbakhsh, K., Larsen, K., DeCoster, T. A., & Miller, R. A. (2007). Bicortical screw fixation of distal fibula fractures with a lateral plate: An anatomic and biomechanical study of a new technique. The Journal of Foot and Ankle Surgery, 46(5), 341–347.

    Article  Google Scholar 

  16. Zhenhua, F., Waizy, H., Ming, X., & Wusheng, K. (2013). Lateral malleolus hook plate for comminuted Weber A and B fractures: A retrospective study. Indian Journal of Orthopaedics, 47(4), 364.

    Article  Google Scholar 

  17. Ramasamy, P., & Sherry, P. (2001). The role of a fibular nail in the management of Weber type B ankle fractures in elderly patients with osteoporotic bone—A preliminary report. Injury, 32(6), 477–485.

    Article  CAS  Google Scholar 

  18. Mast, J., Jakob, R., & Ganz, R. (2012). Planning and reduction technique in fracture surgery. Berlin: Springer.

    Google Scholar 

  19. Moss, L. K., Kim-Orden, M. H., Ravinsky, R., Hoshino, C. M., Zinar, D. M., & Gold, S. M. (2017). Implant failure rates and cost analysis of contoured locking versus conventional plate fixation of distal fibula fractures. Orthopedics, 40(6), e1024–e1029.

    Article  Google Scholar 

  20. Miller, D., Goswami, T., & Prayson, M. (2008). Overview of the locking compression plate and its clinical applications in fracture healing. Journal of Surgical Orthopaedic Advances, 17(4), 271–281.

    PubMed  Google Scholar 

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Funding

There were no external sources of funding for this study.

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Authors and Affiliations

  1. Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, 47 College St, New Haven, CT, 06511, USA

    Assaf Kadar, Steven M. Tommasini, Amit Singla, Brian G. Beitler, Alexander M. Moushey & Michael R. Baumgaertner

  2. Department of Orthopaedic Surgery, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Assaf Kadar

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  1. Assaf Kadar
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  2. Steven M. Tommasini
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  3. Amit Singla
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  4. Brian G. Beitler
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  5. Alexander M. Moushey
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  6. Michael R. Baumgaertner
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Contributions

MB conceived the idea and AK, AS and MB designed the experiment. AK, ST, BB and AM performed the experiment and computations of the results. All authors discussed the results and contributed to the final manuscript.

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Correspondence to Assaf Kadar.

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

Research Involving Animal and Human Rights

Our manuscript does not report on or involve the use of any animal or human data or tissue, and was exempted by the local institutional review board.

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Kadar, A., Tommasini, S.M., Singla, A. et al. Mini-Blade Plate to Obtain Length Across Lateral Malleolus Fractures: Surgical Technique and Biomechanical Evaluation. JOIO 56, 573–579 (2022). https://doi.org/10.1007/s43465-021-00562-8

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  • DOI: https://doi.org/10.1007/s43465-021-00562-8

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