Session X1I - Foot and Ankle

Functional Results of Posterior versus Lateral Plating of Unstable Ankle Fractures: A Prospective Analysis

Toni M. McLaurin, MD¹; Nirmal C. Tejwani, MD¹; Gina Aharonoff, MPH¹; Siraj Bhadsavle, MD¹; Kenneth J. Koval, MD²; Kenneth A. Egol, MD¹;

(n-all authors)

¹New York University, Hospital for Joint Diseases, New York, New York, USA

²Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA

Purpose: This study was designed to compare the functional outcomes and pain scores of displaced lateral malleolus fractures treated with either a lateral neutralization plate or a posterior antiglide plate using data collected in a prospective ankle database.

Method: From October 2000 through December 2004, 309 patients with operative ankle fractures were followed in a prospective database. Of these, 293 had displaced lateral malleolus fractures (OTA type 44-A, 44-B, and 44-C) that were treated operatively. A lateral neutralization plate was used in 158 patients and a posterior antiglide plate in 135, based on surgeon preference. 74% of these patients had a minimum of 1-year follow-up and were included in this study. Analysis of the data was performed to compare the two techniques with respect to patient age, gender, fracture classification, and pain and function at 3 months, 6 months, and 1 year using the AOFAS Ankle-Hindfoot Score. Results were analyzed using Fisher's Exact Test.

Results: There were no differences in the type of plate used based on patient age or gender. Type A and C fractures were more likely to be treated with lateral plating (71.6%) than type B fractures (49.5%). Ankle-Hindfoot Scores showed no statistically significant difference in pain or function between the two groups at 3 months. At 6 months, patients with posterior plates had greater limitation in function (P=0.02) but no difference in pain. At 1 year there was no difference in function, but 21.2 % of patients with posterior plates had moderate or severe pain compared to 7.3% of patients with lateral plates (P<0.01). There was no difference in the total Ankle-Hindfoot Scores at 3 months, 6 months, or 1 year.

Conclusion/Significance: In our large, prospectively followed database, no significant difference was seen in functional limitations at 1 year in patients undergoing lateral neutralization plating compared with those undergoing posterior antiglide plating. There was also no difference in the total Ankle-Hindfoot Score. However, there was a statistically significant difference in the pain component of the Ankle-Hindfoot Score, with posterior plating resulting in more pain at 1 year than lateral plating. These results are different from those previously reported in smaller series, and deserve continued study.