A Biomechanical Comparison of One-Third Tubular Plates Versus Periarticular Plates for Fixation of Osteoporotic Distal Fibula Fractures
ABSTRACT OBJECTIVES:: The purpose of this study was to test the biomechanical properties of locking and non-locking plates, using one-third tubular and periarticular plate designs in an osteoporotic distal fibula fracture model. METHODS:: Twenty four cadaveric specimens, whose bone mineral densities (BMD) were obtained using dual x-ray absorptiometry (DEXA) scans, were tested. The fracture model simulated an OTA 44-B2.1 fracture. The constructs included: 1. Non-locking one-third tubular plate (NTT); 2. Locking one-third tubular plate (LTT); 3. Non-locking periarticular plate (NPA); and 4. Locking periarticular plate (LPA). The specimens underwent axial loading followed by torsional loading to failure. Statistical analysis was performed using Kruskal-Wallis testing, and further analysis with Mann-Whitney testing. RESULTS:: The periarticular plates had greater rotational stiffness compared to the one-third tubular plates (p=0.04). The non-locking plates had greater torque to failure than the locking plates (p=0.01). The NTT had greater torque to failure than the LTT (p=0.03). No significant differences were found in any of the comparisons regarding axial stiffness. CONCLUSIONS:: In biomechanical testing using an osteoporotic model of OTA 44-B2.1 fractures, periarticular plates were superior to one-third tubular plates in rotational stiffness only. Locking plates did not outperform their non-locking counterparts. Periarticular plates should be considered when treating osteoporotic distal fibula fractures, but one-third tubular plates and non-locking plates provide adequate fixation for these injuries.
- Injury 07/2013; 60. DOI:10.1016/j.injury.2013.06.026 · 2.46 Impact Factor
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ABSTRACT: The use of locking plate technology in foot and ankle surgery has increased over the last decade. Reported applications include fracture repair, deformity correction, and arthrodesis. There is limited evidence, however, to guide clinicians with regard to the appropriate and optimal use of this technology. This work aims to examine the current biomechanical and clinical evidence comparing locking construct technology to other forms of fixation in the field of foot and ankle surgery.02/2014; 35(5). DOI:10.1177/1071100714523274
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ABSTRACT: Background Polyaxial locking plates are becoming popular for the fixation of distal fibula fractures. This study establishes how construct stiffness and plate loosening, measured as range of motion, differs between lateral and posterolateral plate location. Materials and methods Seven matched pairs of cadaver fibulae were osteotomized in standardized fashion to produce a Weber type B distal fibula fracture. The fragments were fixated with an interfragmentary lag screw and polyaxial locking plates, with one fibula in each pair receiving a posterolateral anti-glide-plate, and the other a lateral neutralization-plate. In a biomechanical test, the bending and torsional stiffnesses of the constructs and the ranges of motion (ROM) were measured and subjected to a paired comparison. Results The laterally plated group had a higher median (interquartile range) bending stiffness (29.2 (19.7) N/mm) and a smaller range of motion (2.06 (1.99) mm) than the posterolaterally plated group (14.6 (20.6) N/mm, and 4.11 (3.28) mm, respectively); however, the results were not statistically significant (pbending = 0.314; pROM = 0.325). Similarly, the torsional stiffness did not differ significantly between the two groups (laterally plated: 426 (259) Nmm/degree; posterolaterally plated: 248 (399) Nmm/degree; ptorsion = 0.900). The Range of Motion measurements between the two groups under torsional loading were also statistically insignificant (laterally plated: 8.88 (6.30) mm; posterolaterally plated: 15.34 (12.64) mm; pROM = 0.900). Conclusion In biomechanical cadaver-model tests of Weber type B fracture fixation with polyaxial locking plates, laterally plated constructs and posterolaterally plated constructs performed without significantly difference. Therefore, other considerations, such as access morbidity, associated injuries, patient anatomy, or surgeon's preference, may guide the choice of plating pattern. Further clinical studies will be needed for the establishment of definitive recommendations. Clinical relevance Information on the behavior of polyaxial locking plates is relevant to surgeons performing internal fixation of distal fibula fractures.Foot and Ankle Surgery 09/2014; 20(3). DOI:10.1016/j.fas.2014.03.005