Fri., 10/14/11 Knee, Foot & Ankle, Paper #61, 4:10 pm OTA-2011
Posterolateral Antiglide Versus Lateral Plating for SE Pattern Ankle Fractures: A Multicenter Randomized Control Trial
Paul Tornetta, III, MD1; Laura S. Phieffer, MD2; Clifford B. Jones, MD3; Janos P. Ertl, MD4; Brian H. Mullis, MD4; Kenneth A. Egol, MD5; Michael J. Gardner, MD6;
William M. Ricci, MD6; David C. Teague, MD7; William Ertl, MD7; Cory A. Collinge, MD8;
Ross K. Leighton, MD9; Ojas Joshi, MS1;
1Boston University Medical Center, Boston, Massachusetts, USA;
2Ohio State University Medical Center, Columbus, Ohio, USA;
3Orthopaedic Associates of Michigan, Grand Rapids, Michigan, USA;
4Indiana University, Indianapolis, Indiana, USA;
5NYU Hospital for Joint Disease, New York, New York, USA;
6Washington University, St. Louis, Missouri, USA
7University of Oklahoma, Oklahoma City, Oklahoma, USA;
8Orthopaedic Associates – Fort Worth, Fort Worth, Texas, USA;
9Halifax Infirmary, Halifax, Nova Scotia, Canada
Purpose: Rotational ankle fractures are among the most common injuries seen by orthopaedic surgeons, yet there is no agreement regarding plate positioning when fixing these fractures. The purpose of this study was to evaluate the patient-based and local outcomes of posterolateral antiglide versus lateral plating of SE (supination–external rotation) pattern ankle fractures in a randomized trial.
Methods: 233 patients were randomized to posterolateral antiglide (119) or laterally based (114) distal fibular plates. There were 130 women and 103 men, with a mean age of 43 years (range, 18-77 years). Patients were assessed with a physical examination looking for lateral tenderness, peroneal symptoms, palpable or irritating hardware, range of motion, and an AOFAS (American Orthopaedic Foot & Ankle Society) and SMFA (Short Musculoskeletal Function Assessment) at 3, 6, and 12 months. Wound sensitivity was graded on a 5- point scale.
Results: AOFAS scores averaged 80.5, 86.4, and 89 at 3, 6, and 12 months and did not differ between groups (P = 0.76). SFMA scores averaged 26, 17, and 13, and the bother index averaged 24, 16, and 13.5 at 3, 6, and 9 months and did not different between groups (P = 0.5). Hardware was not palpable in 71%, 61%, and 52% of patients after antiglide plating, and 55%, 65%, and 44% of those after lateral plates at 3, 6, and 12 months (different only at 3 months; P = 0.03). Peroneal tendons were normal in 90% of antiglide and 94% of laterally based plated patients, with only 3 patients reporting irritation with activities of daily living (all in the lateral group). Wound sensitivity was completely absent in 83%, 77%, and 90% of antiglide and 72%, 80%, and 82% for lateral plates at 3, 6, and 12 months. Wound sensitivity was not different between the groups at any time point (Fisher’s exact test; P = 0.37). There were 3 wound complications (2 infections) in the antiglide group and 2 in the lateral group. Eight patients had plate removal (5 lateral and 3 antiglide). Range of motion averaged 11° dorsiflexion to 35° of plantar flexion in both groups.
Conclusions: We compared posterolateral antiglide with lateral plating for SE pattern fibula fractures; no differences in patient-based outcomes (AOFAS and SMFA), wound complications, wound sensitivity, or peroneal irritation were noted up to 1 year. Minor differences favoring antiglide plates were seen at 12 weeks, which were not present in further follow-up. The rates of hardware and peroneal irritation are similar in both groups. We found no advantage of one technique over the other in any outcome parameter despite prior reports of hardware irritation for lateral plates and peroneal irritation with antiglide plates.
Alphabetical Disclosure Listing (628K PDF)
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.