Antiglide plating for distal fibula fractures caused by supination-external rotation injury

Abstract

Supination-external rotation type of fracture is the most common pattern of ankle fractures. Anatomical reduction of ankle is always desired and poor reduction usually leads to shortening of fibula, or alter the biomechanics of ankle leading to chronic pain as a result of failure of fixation always. Both lateral and antiglide plating of fibula achieve in accurate anatomical reduction of these fractures. But, maintaining the reduction until bony union is also required to avoid failure of hardware or non union. Antiglide construct enhances biomechanics strength of the fixation device due to its anti gliding effect of the applied plate upon weight bearing and thereby is more favourable. This study evaluated clinical outcomes and complications seen in fixations done by antiglide technique done during 2018-2021 among patients admitted with SER pattern injuries at our institute. A total of 24 patients were included in the study. Mean operative time in the study group was 57.5 ± 27.4 (range 20–120) minutes. The most commonly used plates were five-hole plates in 10 (42%) patients, six holed plates in 10 (42%) patients and seven holed in 4 (16%) patients. The median number of screws distal to the fracture line in the antiglide plate was 0.5 (range 0–2); 10 (50%) fibulas with no fixation, 8 (40%) with one and 2 (10%) with two screws. The AOFAS in the antiglide group performed at one year after surgery was 94.5 ± 6.0 (range 85–100).We conclude that the use of the antiglide plate in a posterolateral position, without using unreasonable distal screws, is an appropriate method of fixation in every short oblique lateral malleolus fractures occurring as a part of SER pattern injury of ankle.