A Biomechanical Comparison of One-Third Tubular Plates Versus Periarticular Plates for Fixation of Osteoporotic Distal Fibula Fractures

Objectives: The purpose of this study was to test the biomechanical properties of locking and nonlocking plates using one-third tubular and periarticular plate designs in an osteoporotic distal fibula fracture model.Methods: Twenty-four cadaveric specimens, whose bone mineral densities were obtained using dual x-ray absorptiometry scans, were tested. The fracture model simulated an OTA 44-B2.1 fracture. The constructs included (1) nonlocking one-third tubular plate, (2) locking one-third tubular plate, (3) nonlocking periarticular plate, and (4) locking periarticular plate. The specimens underwent axial loading followed by torsional loading to failure. Statistical analysis was performed using Kruskal-Wallis testing and further analysis with Mann-Whitney testing.Results: The periarticular plates had greater rotational stiffness compared with the one-third tubular plates (P = 0.04). The nonlocking plates had greater torque to failure than the locking plates (P = 0.01). The nonlocking one-third tubular plate had greater torque to failure than the locking one-third tubular plate (P = 0.03). No significant differences were found in any of the comparisons regarding axial stiffness.Conclusions: In biomechanical testing using an osteoporotic model of OTA 44-B2.1 fractures, periarticular plates were superior to one-third tubular plates in rotational stiffness only. Locking plates did not outperform their nonlocking counterparts. Periarticular plates should be considered when treating osteoporotic distal fibula fractures, but one-third tubular plates and nonlocking plates provide adequate fixation for these injuries.