A comparison of bone union and complication rates between locking and non-locking plates in distal fibular fracture: Retrospective study of 106 cases

Injury. 2019 Dec;50(12):2324-2331. doi: 10.1016/j.injury.2019.10.001. Epub 2019 Oct 7.


Background: Ankle fractures represents the third most frequent fracture in elderly patients. There is a current tendency to fix long bones fractures with locking plates. However, we rarely find published accounts about the use of locking plates in distal fibula fractures, except for biomechanical ones, studying human cadaveric fibula.

Objectives: The main objective was to compare radiographic bone union rates at 6 and 12 weeks of follow up, then wound complications and hardware removal rates, and construct cost.

Study design & methods: We retrospectively analyzed 105 patients who underwent surgery with locking plates or non-locking plates over a two-year period, out of which 42 patients were treated with non-locking plates (VIVES™ - Stryker) and 63 with locking plates (VariAx™ - Stryker,). We analyzed bone union on anterior posterior and lateral X-rays of the ankle. We collected data of wound complications and hardware removal from patient records. Multiple linear regression techniques were performed after identifying dependent variables.

Results: There was no significant difference between non-locking and locking plates in the radiographic bone union rate of distal fibula, respectively at 6 and 12 post-operative weeks (85.71% vs. 81%; p = 0.525 and 97.62% vs. 96.83%; p = 1). No significant difference was found in the wound complication rate between the two groups (11.9% vs. 11.12%; p = 0.9). No significant differences were found in the hardware removal rate, either with or without operative site's infection (respectively: 30.95% vs. 39.68%; p = 0.361 and 21.42% vs. 38.09%; p = 0.071). Cost efficiency is in the favor of non-locking plates.

Conclusion: Non-locking constructs are as effective as locking constructs in the treatment of displaced distal fibula fractures at a substantially lower cost. High-quality randomized controlled trials are needed in the future to verify the finding of this study.

Keywords: Ankle fracture; Bone union; Distal fibula; Locking plate.

MeSH terms

  • Aged
  • Ankle Fractures* / diagnosis
  • Ankle Fractures* / epidemiology
  • Ankle Fractures* / surgery
  • Bone Plates / adverse effects
  • Female
  • Fibula* / diagnostic imaging
  • Fibula* / injuries
  • Fibula* / surgery
  • Fracture Dislocation* / diagnosis
  • Fracture Dislocation* / etiology
  • Fracture Dislocation* / surgery
  • Fracture Fixation, Internal* / adverse effects
  • Fracture Fixation, Internal* / instrumentation
  • Fracture Fixation, Internal* / methods
  • Fracture Healing*
  • France / epidemiology
  • Humans
  • Male
  • Outcome Assessment, Health Care
  • Postoperative Complications* / diagnosis
  • Postoperative Complications* / epidemiology
  • Postoperative Complications* / etiology
  • Postoperative Complications* / surgery
  • Radiography / methods
  • Reoperation / methods
  • Reoperation / statistics & numerical data
  • Time Factors