LOWER IMPLANT REMOVAL RATES OCCUR FOLLOWING POSTEROLATERAL ANTIGLIDE FIXATION FOR DISTAL FIBULA FRACTURES

Distal fibula fractures are a common injury (1), often requiring surgical management. Surgical fixation techniques described include intramedullary fixation, tension band wiring, lateral plating, locking plate fixation, and posterolateral antiglide plating. Biomechanical studies have shown antiglide plating to be superior to lateral plating. Lateral implants can also result in soft-tissue irritation (2). Despite this, lateral plating remains the most commonly performed technique (1). This study aims to directly compare the outcomes of posterolateral antiglide fixation of distal fibula fractures simultaneously with those of lateral plating, dual plating, locking plate fixation, and intramedullary fixation for the first time. We hypothesized that the antiglide plating technique will have lower rates of implant removal, wound complication, infection, and overall secondary surgery rates. This novel data will inform the practice of orthopaedic surgeons for this common procedure, potentially helping improve patient outcomes and reduce unnecessary cost and reduce resource utilization incurred due to secondary surgery. A multi-centre retrospective observational cohort study was performed using data collected from a provincial healthcare data repository. Eligible patients were 18 years of age and older with an isolated ankle fracture that underwent surgical fixation within the province from July 1st to December 31st, 2016, and July 1st to December 31st, 2019. Patients had at minimum two follow-up visits after surgery. Those with multiple injuries, open fractures, pathologic fractures, and pre-existing ankle implants were excluded. Radiographic and chart reviews were performed on included patients. The primary outcome measure was the rate of secondary surgery for implant removal. Secondary outcomes included would complications and infection rate. Pearson's Chi-squared, ANOVA, Kruskal-Wallis rank sum, t-tests, and Fisher's exact tests were used as appropriate. The study included 1525 patients with a mean age of 47 years (std 17.2), 55.9% were female. Lateral plating was the most common fixation technique (74.2%). Secondary surgery for implant removal was performed on 364 patients (23.8%). Pain was the most frequent reason for removal. The mean age, rate of secondary surgery for implant removal, and rate of antibiotic use is listed in Table 1. Figure 1 shows the odds ratios for implant removal of the various fibula fixation types compared to posterolateral antiglide plating. Lateral plating continues to be the most used method of distal fibular fixation. The overall rate of reoperation for implant removal (23.8%) was similar to previously published rates of reoperation. Posterolateral antiglide plating had the lowest rate of reoperation for implant removal of all fixation types and was over 2-times less likely to be removed compared to lateral plating. Locking plates were 2.5-times more likely to require removal. For any figures or tables, please contact authors directly.