Union rates of Weber B fibular fractures: A retrospective comparison of lateral locking plate fixation with and without interfragmentary lag screws

Abstract

Background

Plate fixation with an interfragmentary lag screw is often used for Weber B fibular fractures. However, consensus is lacking regarding whether lateral locking plate fixation without a lag screw is also a viable option for Weber B fractures.

Purpose

Compare union rates of Weber B fibular fractures fixated using a lateral locking plate and lag screw versus a lateral locking plate-only.

Study Design

Retrospective cohort study.

Methods

A retrospective review was conducted on patients who underwent ankle open reduction internal fixation (ORIF) at a single institution between 01/01/2022 and 01/01/2024. Patients had a minimum of a 12 month follow-up. Primary outcome measured included fracture union within 12 weeks which was defined as radiographic evidence of bridging callus across the fracture site with resolution of fracture line, painless weightbearing, and minimal or no tenderness on palpation over the fracture site. Secondary outcomes included time to union and complication rates.

Results

Seventy-one patients were included, 41 of which were treated with a plate and lag screw, and 30 with a plate-only. There was no significant difference in union rates (plate + lag screw: 97.56% vs plate-only 93.33%, p = 0.38) or time to union (plate + lag screw: 8.45 weeks vs plate-only 9.10 weeks, p = 0.23). The plate-only group showed a slightly lower complication rate, although not statistically significant (p = 0.76).

Conclusion

With no significant differences observed in union rates, time to union, or complication rates, plate-only fixation seems to be a reliable alternative when insertion of an interfragmentary lag screw may not be feasible.