Surgical treatment of a displaced lateral malleolus fracture: The antiglide technique versus lateral plate fixation

Objectives: To assess the outcomes of the surgical management of "isolated" displaced lateral malleolar fractures, comparing the techniques of lateral plating and antiglide plating as described previously. Design: This is a retrospective review, being largely a surgeon-randomized comparative study. Setting: The study was carried out at a university teaching hospital that serves as a provincial trauma referral service and provides local community care. The senior surgeons are all orthopaedic trauma subspecialists. Patients: A total of 193 patients meeting our inclusion criteria, with isolated lateral malleolus fractures surgically treated at the Vancouver General Hospital between 1987 and 1998, were studied. Intervention: Eighty-five were treated with antiglide plating, whereas the remaining 108 patients underwent traditional lateral plating. Main Outcome Measures: The functional results were evaluated with the ankle scoring system described previously. We also compared the complication rates, including failure of fixation, infection, wound dehiscence, and need for hardware removal. Results: Both groups were comparable for age, sex distribution, mechanism of injury, and occupation. There was no difference in ankle score, function, and infection rate. The incidence of wound dehiscence and reoperation for hardware removal was slightly higher in the lateral plate group, but the difference was not statistically significant. Conclusions: The outcome of the surgical management of a displaced lateral malleolus fracture is comparable with both techniques. Although few studies have reported some advantages using the antiglide technique, our data do not support one technique over the other.