Comparison of lateral locking plate and antiglide plate for fixation of distal fibular fractures in osteoporotic bone: A biomechanical study

Objectives: The purpose of this study was to compare the biomechanical properties of posterolateral antiglide plating and lateral locked plating for fixation of displaced short oblique fractures of the fibula in osteoporotic bone. Methods: Short oblique fractures of the distal fibula at the level of the syndesmosis were simulated with a fibular osteotomy and ligamentous sectioning in 18 paired fresh frozen ankles. The fractures were fixed with either a lateral locking plate with an independent lag screw or a posterolateral antiglide plate with a lag screw through the plate. The specimens were tested under a torsional load to failure. The torque to failure, angular rotation at failure, and construct stiffness of the two groups were compared. Results: The torque to failure and construct stiffness were significantly greater on the side with the posterolateral antiglide plate than on the side with the the lateral locking plate (P = 0.01 and 0.005, respectively). Conclusions: The posterolateral antiglide plate demonstrated improved biomechanical stability as compared to the lateral locking plate in osteoporotic bone. In situations where fixation needs to be optimized, use of an antiglide plate may be favored over a lateral locking plate construct.