SLR - March 2018 - Marcus P. Richardson
Reference: Moss L, Kim-Orden M, Ravinsky R, Moshino C, Zinar D, Gold S. Implant Failure Rates and Cost Analysis of Contoured Locking Versus Conventional Plate Fixation of Distal Fibula Fractures. Orthopedics. 2017 September 5; 40(6) e1024–e1029.Reviewed By: Marcus P. Richardson, DPM
Residency Program: Grant Medical Center, Columbus OH
Podiatric Relevance: Fractures of the ankle are one of the most common fractures treated by foot and ankle surgeons. Traditionally, these fracture fixations included the use of one-third tubular plating. Contoured locking plates are a newer technology and have become increasingly popular over the last decade. While locking plates have proven to be advantageous in comminuted fractures and osteoporotic bone, the cost of locking plates is considerably higher compared to one-third tubular plates. Given the current economic climate in healthcare, it is becoming more important for medical providers to provide therapeutic, safe and cost-effective treatment modalities. The hypothesis of this study was that there would be no significant difference between to the two plate constructs, and there would be a financial advantage to using the cheaper one-third tubular plates.
Methods: The authors retrospectively identified 330 patients who sustained a Weber B ankle fracture treated surgically with either one-third tubular plate or contoured locking plates between 2010 and 2013. All patients were kept nonweightbearing for eight weeks and were seen in office at two and four weeks postoperatively and then on a case-specific basis. Patient demographics and outcomes were statistically analyzed with SPSS software.
Results: Both groups had similar body mass index, prevalence of diabetes, surgical delay time and follow-up. The locking plate group was significantly older at 44 years old compared to 37.9 years old in the nonlocking group. No failures of the plates or loss of fixation occurred in either group. Five patients required revisional surgery for syndesmotic fixation with four of these being in the nonlocking group. The rate of deep infection requiring removal of hardware was 6.2 percent in the locking group compared to 1.4 percent in the nonlocking group. The investigators preformed cost analysis revealing that nonlocking plates cost about $292 on average compared to contoured locking plates at $1,109.
Conclusion: This study was the first to compare failure rates of contoured locking plates versus one-third tubular plates and found no failure of hardware for either group. There were no significant differences in complication rates between the two groups. With a difference of approximately $800 per plate and with approximately 60,000 locking plates per year, there could be a potential savings of $60 million annually. There were several limitations to this study, including lack of long-term follow-up and no subjective clinical or functional results. This study showed that one-third tubular plates are still a cost-effective treatment option for Weber B ankle fractures.