Minimally Invasive Plate Osteosynthesis of the Distal Fibula With the Locking Compression Plate: First Experience of 20 Cases

Objectives: The aim of this study was to evaluate the clinical feasibility and the possible complications associated with minimally invasive plate osteosynthesis of the distal fibula. Design/Setting: Regional county hospital. Patients/Participants: All patients with Orthopaedic Trauma Association 42, 43, 44 fractures of the distal tibia requiring plate fixation of the distal fibula were included in this cohort study. A consecutive series of 701 internally fixed fractures of tibia and ankle yielded 20 fibular fractures treated with this technique. Intervention: Fractures were treated with the minimally invasive plate osteosynthesis technique using an angular stable screw-plate system for the fibula. Main Outcome Measurements: Clinical and radiologic outcomes at 24 months. Results: Seventeen fractures healed without complication at an average of 9 weeks. Three aseptic nonunions were recorded: one in a pilon fracture (Orthopaedic Trauma Association 43-C3) and one in a distal lower leg fracture (Orthopaedic Trauma Association 43-A3), both with severe closed soft tissue injury (as a result of a crush mechanism). The third one was in an ankle fracture dislocation (OTA 44-C1) with delayed treatment and inadequate reduction of the simple fibula fracture. Conclusion: Although this technique is comparable to minimally invasive plate osteosynthesis in the tibia or femur, it appears to be more difficult as a result of small bone size. As a result, we reserve this technique for selected complex fractures of the distal fibula with critical soft tissue conditions.