gms | German Medical Science

Objectives: The most common method of surgical stabilization of fibular fractures is plate osteosynthesis. Despite its ubiquity, there is a dearth of reports on implant-related outcomes and complications. The purpose of this study was to report on complications and hardware removal after plate fixation of distal fibula fractures.

Methods: A retrospective chart analysis and review of radiographic images was performed of 461 ankle fractures between 2011 and 2017. In 404 cases, a fibular fracture was treated surgically; 94.1% underwent tubular plate and 5.9% locking plate fixation. The primary outcome was radiographic union with a mean follow-up of 11.6 months. Minor and major complications were recorded, as well as the rate of hardware removal.

Results and conclusion: The union rate with plate fixation was 99.5% (402/404). The overall complication rate was 19.3% (n=78/404). 79.5% (62/78) of these complications were considered minor. These complications included erythema, heterotopic ossification, neuropraxia, delayed union and deep vein thrombosis. 20.5% (16/78) of the complications were considered major. These complications included deep infection, non-/malunion, and osteomyelitis. Subsequent surgery was needed in 7 cases (1.7%, or 7/404). In another 93 patients, hardware related symptoms were identified of which 23 underwent syndesmosis screw removal (5.7%) and 54 hardware removal (13.4%). No correlation to the fixation technique was identified.

This study shows a low complication rate and a high union rate of 99.5% for fibular plate osteosynthesis in a large cohort. Any other treatment including other fixation techniques will need to show an equivalent or better complication and reoperation profile.