A Multicenter Randomized Trial Comparing Antiglide and Lateral Plate Fixation in Ankle Fractures
Condition: Ankle Injuries
MeSH terms: Fractures, Bone; Ankle Fractures; Ankle Injuries
Study type: Interventional

Summary: 
      The role of operative fixation of unstable, displaced lateral malleolus fractures is
      well-established (Mayer, Mak, and Yablon). However, the optimal type of fixation remains the
      subject of debate. Lag screw fixation alone is only appropriate for long oblique fractures in
      younger patients (Tornetta). For all other patients, the choices for fibular stabilization
      most commonly involve the use of plates and screws which can be placed on either the lateral
      or posterior side of the bone, with or without lag screws. Lateral plating remains the most
      popular option, but since the description of posterior plating in 1982 (Brunner), reports in
      the literature have demonstrated some advantages of posterior over lateral plating (Ostrum,
      Treadwell, Winkler, and Wissing) . These advantages include less dissection, less palpable
      hardware, and decreased likelihood of intra-articular screw placement. However, there is only
      a single retrospective study in the published literature directly comparing these two methods
      (Lamontagne).
    

Detailed description: 
      Since it was first described in 1982, posterior antiglide plating has been presented as an
      attractive alternative to lateral plating of distal fibula fractures. Biomechanical studies
      have shown it to be a stronger construct than lateral plating, and other purported advantages
      include less dissection, decreased potential for intra-articular screw placement, and less
      palpable hardware decreasing the need for hardware removal.However, although posterior
      plating has become an accepted technique for operative management of these injuries, there is
      little clinical information in the literature regarding this treatment, and only one
      published retrospective study directly comparing posterior to lateral plating.

      In 1996, Ostrum published a prospective study evaluating posterior plating in 32 patients,
      but only compared his results to a cohort of patients treated with lateral plating that was
      not part of his actual study group.Patel et al. recently presented a retrospective comparison
      of both techniques, but their study only included 29 patients in the lateral plating group
      and 23 in the posterior group.In both these studies, posterior plating was felt to be
      superior to lateral plating based on both the decrease in complications/re-operations related
      to symptomatic hardware, and improved function and pain scores.

      However, in a much larger study, Lamontagneet al. showed no differences in operative time,
      complications or hardware removal rates in 193 patients reviewed retrospectively, and
      concluded that they could not recommend one treatment method over the other. They even
      elected not to proceed with a planned prospective study based on their results.A recent
      retrospective analysis of 70 patients showed a 43% incidence of need for hardware removal due
      to pain, with 30% of these patients having peroneal tendon lesions identified
      intra-operatively.
    

Intervention name(s): Antiglide Plate; Lateral Plate
Intervention type(s): Device; Device
Intervention description(s): A plate is placed behind the broken ankle and secured with screws; A metal plate is placed to the side of the broken ankle and is secured with screws
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Ankle Fractures; Displaced Lateral Malleolus Fractures; Antiglide Plating; Lateral Plating