Research Articles

The Efficiency of Locking Compression Plates versus Dynamic Compression Plates in the Treatment of Low Distal Fibula Fracture: A Randomized Clinical Trial

Abstract

Background: Uncertainties remain as to which type of plate [locking compression plate (LCP) or dynamic compression plate (DCP)] is more efficient and cost-effective in fixing and stabilizing the fractures. We aimed to compare the clinical utility of the two types of plates including LCPs and 3.5-mm DCPs in the treatment of low distal fibula fracture (distal lateral malleolus fractures).

 

Methods: This randomized single-blinded clinical trial was performed on 54 patients with distal fibula fractures who were candidates for surgical treatment using compression plate fixation. The patients were randomly assigned into two groups scheduled for treatment with fixation of LCPs or with 3.5-mm T-plates (DCPs). The patients were finally followed-up for two years to assess the clinical outcome of the procedures.

 

Results: No difference was revealed between the two groups in the prevalence of postoperative infection, nonunion, wound dehiscence, skin reactions, and local surgical pain. The mean functional score [Olerud-Molander Ankle Score (OMAS)] in the DCP and LCP groups was 85.33 ± 4.92 and 84.85 ± 5.12, respectively, indicating no difference between the groups (P = 0.726).

 

Conclusion: In the treatment of low distal fibula fractures, the use of LCPs and 3.5mm DCPs can similarly result in improving functional status with minimal postoperative complications. Due to the similarity of the consequences of using both plates and the fact that the DCP type is more cost-effective and available in remote and deprived areas, this type seems to be preferred.

 

1. Bagheri N, Khabiri SS, Mortazavi SJ, Farzan M. Should we pay attention to the fibular segmental fracture in the management of leg fractures? J Orthop Spine Trauma. 2016;2(3). e9503. doi: 10.5812/jost.9503.

2. Pott P. Some few general remarks on fractures and dislocations. London, UK: Hawes, Clark, and Collins; 1768.

3. Manchanda K, Nakonezny P, Sathy AK, Sanders DT, Starr AJ, Wukich DK. A systematic review of ankle fracture treatment modalities in diabetic patients. J Clin Orthop Trauma. 2021;16:7-15. doi: 10.1016/j.jcot.2020.12.013. [PubMed: 33717936]. [PubMed Central: PMC7920114].

4. De Las Heras RJ, Lledo AA, Torres SC, Luna MA. Operative treatment of ankle fractures: predictive factors affecting outcome. Cureus. 2020;12(10):e11016. doi: 10.7759/cureus.11016. [PubMed: 33094040]. [PubMed Central: PMC7574997].

5. Schlickewei C, Krahenbuhl N, Rolvien T, Sturznickel J, Yarar-Schlickewei S, DeKeyser G, et al. Surgical outcome of avulsion fractures of the distal fibula: A systematic literature review. Arch Orthop Trauma Surg. 2021. doi: 10.1007/s00402-021-04256-6. [PubMed: 34820695].

6. Odak S, Ahluwalia R, Unnikrishnan P, Hennessy M, Platt S. Management of posterior malleolar fractures: A systematic review. J Foot Ankle Surg. 2016;55(1):140-5. doi: 10.1053/j.jfas.2015.04.001. [PubMed: 26100091].

7. Bartonicek J, Rammelt S, Tucek M. Posterior malleolar fractures: Changing concepts and recent developments. Foot Ankle Clin. 2017;22(1):125-45. doi: 10.1016/j.fcl.2016.09.009. [PubMed: 28167058].

8. DeKeyser GJ, Kellam PJ, Haller JM. Locked plating and advanced augmentation techniques in osteoporotic fractures. Orthop Clin North Am. 2019;50(2):159-69. doi: 10.1016/j.ocl.2018.12.002. [PubMed: 30850075].

9. Grant KD, Busse EC, Park DK, Baker KC. Internal fixation of osteoporotic bone. J Am Acad Orthop Surg. 2018;26(5):166-74. doi: 10.5435/JAAOS-D-16-00142. [PubMed: 29473833].

10. Mahmoudi E, Nabian MH. Chronic injury of distal tibiofibular

syndesmosis with ankle fracture dislocation: A case report. J
Orthop Spine Trauma. 2020;6(1):16-9. doi:

10.18502/jost.v6i1.4537.

11. Macera A, Carulli C, Sirleo L, Innocenti M. Postoperative complications and reoperation rates following open reduction and internal fixation of ankle fracture. Joints. 2018;6(2):110-5. doi: 10.1055/s-0038-1653949. [PubMed: 30051108]. [PubMed Central: PMC6059857].

12. Backer HC, Greisberg JK, Vosseller JT. Fibular plate fixation and correlated short-term complications. Foot Ankle Spec. 2020;13(5):378-82. doi: 10.1177/1938640019873539. [PubMed: 31538819].

13. Tejwani NC, Wolinsky P. The changing face of orthopaedic trauma: locked plating and minimally invasive techniques. Instr Course Lect. 2008;57:3-9. [PubMed: 18399565].

14. Kurup H, Hossain M, Andrew JG. Dynamic compression plating versus locked intramedullary nailing for humeral shaft fractures in adults. Cochrane Database Syst Rev. 2011;(6):CD005959. doi: 10.1002/14651858.CD005959.pub2. [PubMed: 21678350].

15. Kim HJ, Oh JK, Hwang JH, Park YH. The use of T-LCP (locking compression plate) for the treatment of the lateral malleolar fractures. Eur J Orthop Surg Traumatol. 2013;23(2):233-7. doi: 10.1007/s00590-012-0952-9. [PubMed: 23412457].

16. Koshimune M, Kamano M, Takamatsu K, Ohashi H. A randomized comparison of locking and non-locking palmar plating for unstable Colles' fractures in the elderly. J Hand Surg Br. 2005;30(5):499-503. doi: 10.1016/j.jhsb.2005.04.018. [PubMed: 16061315].

17. Takemoto RC, Sugi MT, Kummer F, Koval KJ, Egol KA. The effects of locked and unlocked neutralization plates on load bearing of fractures fixed with a lag screw. J Orthop Trauma. 2012;26(9): 519-22. doi: 10.1097/BOT.0b013e31823b3dd1. [PubMed: 22437420].

18. Schepers T, Van Lieshout EM, De Vries MR, Van der Elst M. Increased rates of wound complications with locking plates in distal fibular fractures. Injury. 2011;42(10):1125-9.

10.1016/j.injury.2011.01.009. [PubMed: 21329921].

19. Hasami NA, Smeeing DPJ, Pull Ter Gunne AF, Edwards MJR, Nelen SD. Operative fixation of lateral malleolus fractures with locking plates vs nonlocking plates: A systematic review and meta-analysis. Foot Ankle Int. 2022;43(2):280-90. doi: 10.1177/10711007211040508. [PubMed: 34581226]. [PubMed Central: PMC8841627].

20. MacLeod AR, Simpson AH, Pankaj P. Reasons why dynamic compression plates are inferior to locking plates in osteoporotic bone: A finite element explanation. Comput Methods Biomech
Biomed Engin. 2015;18(16):1818-25. doi:

10.1080/10255842.2014.974580. [PubMed: 25473732].

21. Manoharan G, Singh R, Kuiper JH, Nokes LDM. Distal fibula oblique fracture fixation using one-third tubular plate with and without lag screw - A biomechanical study of stability. J Orthop. 2018;15(2):549-52. doi: 10.1016/j.jor.2018.05.011. [PubMed: 29881191]. [PubMed Central: PMC5990239].
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IssueVol 9, No 2 (2023) QRcode
SectionResearch Articles
DOI https://doi.org/10.18502/jost.v9i2.12626
Keywords
Fibula Fracture Fixation Clinical Trial
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How to Cite
1.
Mehrvar A, Minator Sajjadi M, Okhovatpour MA, Sarlak S, Ahmadi-Abdashti A, Zandi R. The Efficiency of Locking Compression Plates versus Dynamic Compression Plates in the Treatment of Low Distal Fibula Fracture: A Randomized Clinical Trial. J Orthop Spine Trauma. 2023;9(2):74-7.