Department of Orthopaedic Surgery, Canberra Hospital, Garran, ACT, Australia.
Trauma and Orthopaedic Research Unit, Australian National University Medical School, Garran, ACT, Australia.
Foot Ankle Int. 2022 Jun;43(6):850-859. doi: 10.1177/10711007221079617. Epub 2022 Apr 2.
Distal fibular fractures are extremely common, yet there remains controversy about which type of plating technique is the most appropriate. We aimed to compare clinical and biomechanical outcomes following posterior antiglide plating and lateral neutralization plating for Weber B distal fibular fractures.
A systematic review and meta-analysis of the literature was conducted by two independent reviewers according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We included all comparative studies of distal fibular fracture fixation with either a posterior antiglide plate or a lateral neutralization plate. Our primary outcome of interest was reoperation for hardware removal. Secondary outcomes included hardware discomfort, peroneal tendon irritation, infection, wound complications, and mechanical torque to failure.
A total of 1122 patients with Weber B ankle fractures were included across nine eligible clinical studies, and 76 cadaveric ankles were subject to testing across three eligible biomechanical studies. Meta-analyses revealed a two-fold greater odds of requiring removal of hardware in the lateral plating group compared to the posterior plating group (odds ratio [OR] 2.48, 95% CI 1.58 to 3.91, < .0001), and a three-fold greater odds of experiencing hardware discomfort in the lateral plating group compared to the posterior plating group (OR 2.96, 95% CI 1.83 to 4.80, < .0001). There were no significant differences in rates of peroneal tendon irritation, infection, wound complications, operative time, and torque to failure when comparing the two plating methods.
The results of this review indicate that using posterior antiglide plating for distal fibular Weber B-type fractures is associated with significantly fewer reoperations due to hardware complications and less hardware discomfort compared to lateral neutralization plating. This technique does not appear to increase the risk of peroneal tendon irritation or increase operative time.
腓骨远端骨折极为常见，但对于哪种接骨板技术最为合适仍存在争议。我们旨在比较后向抗滑钢板和外侧中和钢板治疗 Weber B 型腓骨远端骨折的临床和生物力学结果。
两名独立评审员按照系统评价和荟萃分析的首选报告项目指南对文献进行了系统回顾和荟萃分析。我们纳入了所有使用后向抗滑板或外侧中和板固定腓骨远端骨折的比较研究。我们主要关注的结果是因去除内固定而再次手术。次要结果包括内固定不适、腓肠肌腱激惹、感染、伤口并发症和机械抗扭强度。
共有 9 项符合条件的临床研究纳入了 1122 例 Weber B 踝关节骨折患者，3 项符合条件的生物力学研究纳入了 76 例尸体踝关节。荟萃分析显示，外侧接骨板组比后侧接骨板组更需要去除内固定的可能性高出两倍（优势比 [OR] 2.48，95%置信区间 [CI] 1.58 至 3.91， <.0001），且外侧接骨板组比后侧接骨板组更有可能出现内固定不适的可能性高出三倍（OR 2.96，95% CI 1.83 至 4.80， <.0001）。当比较两种接骨板方法时，外侧接骨板组与后侧接骨板组在腓肠肌腱激惹、感染、伤口并发症、手术时间和抗扭强度方面的发生率没有显著差异。
本综述的结果表明，与外侧中和钢板相比，在后向抗滑钢板治疗 Weber B 型腓骨远端骨折时，由于内固定并发症和内固定不适导致的再次手术明显减少。这种技术似乎不会增加腓肠肌腱激惹的风险或增加手术时间。
