Lateral Locking Plate Fixation of Simple Weber B Fibula Fractures Without a Lag Screw Yields Excellent Radiographic Results

Background The most common first-line fixation technique for simple Weber B fibula fractures is a lag screw with lateral neutralization plate. The most common surgical technique for unstable Weber B fibula fracture is one-third semi-tubular plate and cortical screws, implemented with lag screw when appropriate. However, the lag technique can be technically challenging in osteoporotic bone or within fibulas of smaller diameter, and in some cases can result in fragmentation at the fracture site, malreduction, or peroneal irritation. The purpose of this study is to examine an alternative first-line method for routine treatment of simple Weber B fibula fractures. Methods Fifty-two consecutive patients undergoing open reduction internal fixation (ORIF) of a Weber B fibula fracture by a single surgeon were included in this retrospective study. After reduction, a lateral locking plate was applied with cortical screws proximally and locking screws distally. No screw crossed the fracture in any case. Per published precedent, nonunion was defined as either a gap of >3 mm between fracture surfaces >6 months postoperatively or a fracture line >2 to 3 mm wide and sclerosing of the fracture surfaces. Similarly, malunion was defined as one or more of the following: talar tilt >2º, talar subluxation >2 mm, or tibiofibular clear space ≥5 mm. Results The mean (± standard deviation) age of the 52 included patients was 44.2 ± 16.2 years, the mean body mass index was 27.7 ± 6.6 kg/m2, and 63.5% of patients identified themselves as female sex. The mean follow-up was 6.2 (range: 1.5-15) months. In addition to undergoing fixation of the lateral malleolus, 21 patients also underwent fixation of the posterior malleolus, 27 underwent fixation of the medial malleolus, 29 underwent fixation across the syndesmosis, and 7 underwent repair of the deltoid. In all patients, bony anatomic union of the fibula and congruence of the mortise were achieved with no cases of malunion or nonunion. Conclusions The Arbeitsgemeinschaft für Osteosynthesefragen (AO) fixation technique for simple Weber B fractures with a lag screw and lateral neutralization plating has provided good outcomes for decades. We present an alternative technique for ORIF of these fractures with a lateral locking plate and no lag screw. In our series, we evaluated radiographic union and alignment as our primary outcome measures and found no cases of nonunion or malunion. Prospective cohort testing of lateral locking plates versus traditional fixation in the context of patient-centered value is warranted. Level of Evidence: Level III

Lag Screws in Maxillofacial Trauma- A Review

The etiology of mandibular fractures includes mainly assaults and road traffic automobile accidents. Additionally, fall and sports injuries are the foremost common causes for mandibular fractures. Mandibular fractures outnumbered zygomatic and maxillary fractures by a ratio of 6:2:1, respectively. Road traffic accidents is that the most typical etiology, followed by assaults and sport-related injuries. For the management of maxillofacial trauma, the treatment commonly done is open reduction and Internal Fixation using miniplates. Lag screws as compared with plates, have a plus of the necessity of minimum implant material which they also provide maximum stability. The lag screw placement is a simple method of rigid fixation. The choice of the lag screw technique depends on patient factors, kind of fracture, site of fracture, and thus the skill of surgeon. The aim of this review is to assess the efficiency of Lag Screws for the management of maxillofacial trauma.

Biomechanical Comparison of Lag Screw and Non-spiral Blade Fixation of a Novel Femoral Trochanteric Nail in an Osteoporotic Bone Model

PurposeThere is no consensus regarding the advantages of the lag screw type over the blade type for treating femoral trochanteric fractures. We aimed to investigate whether non-spiral blade (Conventional-Blade, Fid-Blade) nails provide better biomechanical fixation than lag screws in a severe osteoporotic bone model.MethodsDifferent severities of osteoporotic cancellous bone were modelled using polyurethane foam blocks of three densities (0.24, 0.16, and 0.08 g/cm3). Three torsional tests were performed using each component for each bone density and the maximum torque was recorded, and the energy required to achieve 30° rotation was calculated. Using a push-in test, the maximum force was recorded, and the energy required to achieve 4-mm displacement was calculated. ResultsFor 0.08-g/cm3 density, the peak torques to achieve 30° rotation, energy required to achieve 30° rotation, peak force to achieve 4-mm displacement, and energy required to achieve 4-mm displacement were significantly greater for Conventional-Blade and Fid-Blade than for Lag Screw. ConclusionsConventional-Blade and Fid-Blade nails exhibited significantly higher values than Lag Screw under any test condition. The blade-type nail component may have a better fixation capability than the lag screw type in a severe osteoporotic bone model.