Are interfragmentary lag screws necessary in surgical treatment of Weber B ankle fractures?

Background: Traditionally, open reduction and internal fixation (ORIF) for Weber B fibular fractures involves placement of a lag screw across the fracture plane along with plate fixation.

Purpose: To compare outcomes of Weber B fractures treated with plate-only (PO) vs. plate and lag screw (PLS) fixation.

Study design: Retrospective cohort study.

Methods: Retrospective review of 318 patients undergoing ORIF for Weber B fractures (2022-2024) was performed. Univariate and multivariate statistics were used to compare patient characteristics and outcomes of those treated with PLS (n=167) vs. those treated with PO (n=151) fixation.

Results: Patients in the PO-group were older, had a greater comorbidity burden (measured as Charlson Comorbidity Index [CCI]), and were more likely to have osteoporosis/osteopenia and diabetes than those in the PLS-group. Further, the PO-group was more likely to present with a trimalleolar fracture. Similar rates of complications (PO: 20.5 vs. PLS: 22.2%, p=0.829), reoperations (PO: 7.9 vs. PLS: 9.0%, p=0.897) and reporting "normal or nearly normal" levels of function at 6-months postoperatively (PO: 54.8 vs. PLS: 60.2%, p=0.630) were observed. After adjusting for age, CCI, osteoporosis/osteopenia, fracture type, and surgical setting in the multivariate regression models there were no significant differences in complication rates, reoperation rates, or patient-reported outcomes at 6-months postoperatively between groups.

Conclusion: Surgical correction of Weber B fractures with a fibular plate yielded similar outcomes with and without placement of a lag screw. While further studies are needed to confirm these findings, plate-only fixation of Weber B ankle fractures appears to be a safe technique.