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Similar results seen with posterolateral and lateral plates for ankle fractures
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SAN ANTONIO — Researchers of a level 1 study comparing posterolateral antiglide and lateral plating for supination-external rotation patterned ankle fractures found that one plating technique was not superior to the other.
During his presentation at the 2011 Annual Meeting of the Orthopaedic Trauma Association, Paul Tornetta III, MD, of Boston University Medical Center, explained the debate about the plating techniques.
“Laterally based fixation tends to be more prominent,” he said. “It has been reported to require removal in up to 50% of cases.” Posterolateral plating has been suggested to provide a stronger fixation, Tornetta said, but is associated with peroneal irritation and up to 43% of patients require removal for peroneal lesions in prior reports.
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Images: Tornetta P |
In a multicentered randomized controlled trial, Tornetta and colleagues studied 119 patients with ankle fractures repaired using posterolateral antiglide plates and 114 with laterally based distal fibular plates. The researchers used patient-based and objective outcomes, including physical examinations for lateral tenderness, peroneal symptoms, palpable or irritating hardware, range of motion and AOFAS and Short Musculoskeletal Function Assessment (SMFA) scores at 3 months, 6 months and 12 months. The investigators used syndesmotic fixation in an equal number of patients in both groups and incision sizes were identical.
“The distance from the tip of the fibula to the plate was understandably closer on the laterally based plates than the posterolateral plates,” Tornetta said. “This probably contributed to our eventual low incidences of posterolateral complications and peroneal lesions.”
The investigators found no significant differences in outcomes between the cohorts. The groups had average AOFAS scores of 80.5, 86.4 and 89 at 3 months, 6 months and 12 months, respectively. SMFA scores were also similar between groups with scores of 26, 17 and 13 at the aforementioned time periods. The Bother index mean scores were 24, 16 and 13.5 at those times.
“The SMFA showed a slight improvement over time in the posterolateral group compared to the lateral group,” Tornetta said. “It is the same for the Bother index. There is a slightly lower number, which indicates it is better in the posterolateral vs. the lateral plate. [However,] it is not statistically significant.”
The researchers found no palpability in 71%, 61% and 52% of patients after posterolateral antiglide plating and 55%, 65% and 44% of patients after lateral plating at 3 months, 6 months and 12 months, respectively. Overall, the team found no hardware irritation in 90% of posterolateral and 94% of lateral patients.
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AP and lateral views of the lateral plate are shown here. |
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“For posterolateral placement, we did see a little bit of a difference with the contoured plate having a higher rate of no peroneal irritation, which is bordering on statistical significance,” Tornetta said.
Three patients in the lateral group reported irritation with activities of daily living. No wound sensitivity was reported in 83% of patients in the posterolateral group at 3 months, 77% at 6 months and 90% at 12 months vs. 72%, 80% and 82% of patients with lateral plates at those time points. The team recorded three wound complications, including two infections, in the posterolateral group and two wound complications in the lateral group. The researchers removed plates from five patients in the lateral group and three patients in the posterolateral antiglide cohort. In both groups, the average range of motion was 11° dorsiflexion and 35° plantar flexion.
“Minor differences favoring antiglide plates were seen at 12 weeks, which were not present at further follow-up,” the authors wrote in their study abstract.
“Plate position is not important, complication rates are similar, there are no significant differences in outcomes between the two groups and it is pretty much the dealer’s choice,” Tornetta said. – by Renee Blisard
Reference:
- Tornetta P, Phieffer LS, Jones CB, et al. Posterolateral versus lateral plating for SE pattern ankle fractures: A multicenter randomized control trial. Paper #61. Presented at the 2011 Annual Meeting of the Orthopaedic Trauma Association. Oct. 12-15. San Antonio.
- Paul Tornetta III, MD, can be reached at Boston University Medical Center, 850 Harrison Ave., 3rd Floor, Boston, MA 02118; 617-414-5212; email: ptornetta@gmail.com.
- Disclosure: Tornetta receives royalties from and is a paid consultant for Smith & Nephew, receives royalties from Wolters Kluwer Health-Lippincott Williams & Willkins and is a board member of the American Orthopaedic Association and the Orthopaedic Trauma Association.