SLR - May 2023 - Fahad Hussain, DPM
Title: Screw-only fibular construct for Weber B ankle fractures: A retrospective clinical and cost comparison to assess feasibility for resource-limited settingsReference: Grisdela P Jr, Williams C, Challa S, Henson P, Agarwal-Harding K, Kwon JY. Screw-only fibular construct for Weber B ankle fractures: A retrospective clinical and cost comparison to assess feasibility for resource-limited settings. Injury. 2022;53(12):4146-4151.
Level of Evidence: 3
Reviewed By: Fahad Hussain, DPM
Residency Program: RWJBH- Community Medical Center
Podiatric Relevance: Ankle fractures are one of the most common injuries sustained worldwide with isolated fibular fractures accounting for a majority of the injuries. Most of the world’s population lives in Low- and Middle-Income Countries (LMICs). The cost of traditional plate fixation constructs may limit surgical treatment resulting in long-term disability. This study aimed to determine if unstable Weber B ankle fracture can be treated with a novel screw-only construct and to assess the cost-effectiveness of this approach by comparing to a more traditional lateral plating technique.
Methods: This is a retrospective study of 27 patients with unstable Weber B ankle fractures treated operatively using from 2020-2021 at a single academic center. In 2020, patients were treated using AO technique (AOT) with plate osteosynthesis neutralizing an interfragmentary screw. In 2021, these injuries were treated with a screw-only technique (SOT) with two fibula pro tibia screws to neutralize an interfragmentary screw. Inclusion criteria included patients over the age of 18 who presented with unstable ankle fractures involving the lateral malleolus. Exclusion criteria included ankle fractures not involving the lateral malleolus, patients under 18, and patients managed non-operatively. Primary outcome variables were osseous healing and anatomic mortise alignment. Secondary outcome variables were additional surgery, infection, total complications, clinical union, and implant cost.
Results:17 AOT and 10 SOT patients were included. All patients demonstrated an anatomic mortise and radiographic/clinical union at 6 weeks. There were no infections or wound healing complications in either group. There were 3 additional surgical interventions in the AOT group and 5 in the SOT group. There was one deep vein thrombosis in the SOT group. The average implant cost of the lateral malleolar fixation was $1,949.97 for the AOT group and $592 for the SOT group.
Conclusions: This study introduced a concept of a novel low-cost fixation strategy for Weber B ankle fractures. The cost of this novel construct is lower than the current standard of plate osteosynthesis. The SOT group showed it was as efficacious at maintaining a stable mortise and achieving radiographic and clinical union at 6 weeks post-operatively. There was a significantly higher rate of hardware removal following fixation with the SOT group. Future studies of this procedure are indicated, as there are limited-resources areas where these fractures might be neglected.