Mid-diaphyseal fibular fractures with syndesmotic disruption: should we plate the fibula?

Foot Ankle Int. 2008 Jun;29(6):587-92. doi: 10.3113/FAI.2008.0587.


Background: The treatment of mid-diaphyseal fibula fractures with syndesmotic disruption is controversial. The purpose of this study was to compare the biomechanical properties of 2 fixation constructs.

Materials and methods: Eight pairs of human cadaveric legs were divided into two groups, both of which had midshaft fibular osteotomies and disruption of all ligamentous support up to the osteotomy level. In Group I, the left legs were fixed with only a 3.5-mm tricortical syndesmotic screw. In Group II, the right legs received this syndesmotic fixation in addition to plating of the fibula. Rotational stability was tested on each ankle in the intact, repaired, and post-cyclical load conditions. Each specimen was ultimately tested to failure in external rotation.

Results: The rotational stability, load to failure, and stiffness were all found to be significantly higher with the plate and syndesmotic fixation repair technique (Group II) than with the syndesmotic fixation only technique (Group I). Furthermore, fixation in Group II improved rotational stability both before and after cyclic loading.

Conclusion: Improved biomechanical properties were found with fibular plating in addition to a syndesmotic screw in a midshaft fibular fracture model with syndesmotic and deltoid injury.

Clinical relevance: This information may be helpful in the decision-making process to optimally treat patients with this fracture pattern.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Bone Plates
  • Cadaver
  • Diaphyses / injuries
  • Female
  • Fibula / injuries*
  • Fracture Fixation, Internal / instrumentation
  • Fracture Fixation, Internal / methods*
  • Fractures, Bone / complications*
  • Fractures, Bone / surgery*
  • Humans
  • Joint Instability / prevention & control*
  • Ligaments, Articular / injuries*
  • Male
  • Middle Aged
  • Weight-Bearing