Department of Orthopaedic Surgery, Seoul St. Mary's Hospital College of Medicine, The Catholic University of Korea, Seoul, Korea.
Department of Orthopaedic Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Orthop Surg. 2021 Dec;13(8):2301-2309. doi: 10.1111/os.13160. Epub 2021 Oct 27.
To compare the clinical outcomes of locking plate (LP) and non-locking one-third tubular plate (TP) fixation, and to provide guidance on plate selection for Danis-Weber type B distal fibular fracture treatment.
In total, 83 patients who underwent plate fixation for Danis-Weber type B distal fibular fractures between March 2013 and July 2018 were retrospectively reviewed: 41 (49.0%) received LPs and 42 (51.0%) received TPs. Patients' demographic data, follow-up durations, the proportion of comminuted fractures, and ankle range of motion were investigated. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, Karlsson scale, Foot and Ankle Ability Measure (FAAM), and Lower Extremity Functional Scale (LEFS) scores were assessed. The radiographic union progression and implant removal time were evaluated, along with postoperative complications. Data from the LP and TP groups were compared statistically.
The mean patient ages were 53.3 ± 17.5 years (range, 16-80 years) and 47.6 ± 17.0 years (range, 14-68 years) in the LP and TP groups, respectively (P > 0.05). The gender distribution did not differ significantly between groups (P > 0.05). Other demographic data also did not differ significantly between groups (P > 0.05). The mean follow-up durations were 16.8 ± 7.7 months (range, 13.0-19.0 months) in the LP group and 16.1 ± 6.2 months (range, 12.0-20.0 months) in the TP group (P > 0.05). Comminuted fractures were observed in 18 of 41 (43.9%) patients with LP and 10 of 42 (23.8%) patients with TP (P > 0.05). Forward bending ankle dorsiflexion was possible at the final follow-up in 82.9% and 85.7% of LP and TP patients, respectively (P > 0.05). The AOFAS ankle-hindfoot scale, Karlsson scale, FAAM, and LEFS scores did not differ significantly between groups at the final follow-up (P > 0.05). The pre-fracture and final postoperative scores on these four instruments did not differ significantly in the LP or TP group (P > 0.05). The mean times to radiographic union progression were 13.5 ± 7.1 weeks and 15.1 ± 10.2 weeks in the LP and TP groups, respectively (P > 0.05). The mean times to implant removal surgery reaffirming solid union were 15.6 ± 5.5 months and 14.8 ± 4.9 months in the LP and TP groups, respectively (P > 0.05). Hardware irritation was detected in five patients in the LP group (12.2%) and three in the TP group (7.1%) (P > 0.05). One patient in the LP group and two in the TP group developed superficial wound infections, which resolved without further surgical intervention.
Conventional TP remains a good option for the fixation of Danis-Weber type B distal fibular fractures, regardless of the biomechanical properties.
比较锁定板（LP）和非锁定三分之一管状板（TP）固定的临床效果，为 Danis-Weber 型 B 型腓骨远端骨折的治疗提供钢板选择指导。
回顾性分析 2013 年 3 月至 2018 年 7 月采用钢板固定治疗 Danis-Weber 型 B 型腓骨远端骨折的 83 例患者：41 例（49.0%）采用 LP，42 例（51.0%）采用 TP。记录患者的人口统计学数据、随访时间、粉碎性骨折比例、踝关节活动范围，采用美国矫形足踝协会（AOFAS）踝-后足量表、Karlsson 量表、足踝能力测量（FAAM）量表和下肢功能量表（LEFS）评分进行评估。评估影像学愈合进展和植入物取出时间，以及术后并发症。比较 LP 和 TP 组的数据。
LP 组患者的平均年龄为 53.3 ± 17.5 岁（范围，16-80 岁），TP 组为 47.6 ± 17.0 岁（范围，14-68 岁）（P > 0.05）。两组患者的性别分布无显著差异（P > 0.05）。其他人口统计学数据也无显著差异（P > 0.05）。LP 组的平均随访时间为 16.8 ± 7.7 个月（范围，13.0-19.0 个月），TP 组为 16.1 ± 6.2 个月（范围，12.0-20.0 个月）（P > 0.05）。LP 组有 18 例（43.9%）和 TP 组有 10 例（23.8%）患者为粉碎性骨折（P > 0.05）。LP 和 TP 患者的最终随访时，前足背屈踝关节背屈均可达 82.9%和 85.7%（P > 0.05）。最终随访时，AOFAS 踝-后足量表、Karlsson 量表、FAAM 和 LEFS 评分在两组间无显著差异（P > 0.05）。LP 或 TP 组患者在术前和最终术后的这些四项仪器评分均无显著差异（P > 0.05）。LP 和 TP 组影像学愈合进展的平均时间分别为 13.5 ± 7.1 周和 15.1 ± 10.2 周（P > 0.05）。LP 和 TP 组植入物取出手术以确认骨愈合的平均时间分别为 15.6 ± 5.5 个月和 14.8 ± 4.9 个月（P > 0.05）。LP 组有 5 例（12.2%）和 TP 组有 3 例（7.1%）患者出现金属刺激（P > 0.05）。LP 组 1 例和 TP 组 2 例患者发生浅表伤口感染，无需进一步手术干预即可痊愈。
对于 Danis-Weber 型 B 型腓骨远端骨折的治疗，无论生物力学特性如何，传统的 TP 仍然是一种很好的固定选择。
