Does a polyaxial-locking system confer benefits for osteosynthesis of the distal fibula: A cadaver study

BackgroundIn plate osteosynthesis involving the distal fibula, antiglide plating is superior to lateral plating in terms of the biomechanical properties. The goal of this study was to examine whether polyaxial-locking implants confer additional benefits in terms of biomechanical stability.MethodsSeven pairs of human cadaveric fibulae were subjected to osteotomy in a standardized manner to simulate an uncomplicated Weber B fracture. The generated fractures were managed with a dorsolateral antiglide plate. To this end, one fibula of the pair was subjected to non-locking plating and the other to polyaxial-locking plating. Biomechanical tests included quantification of the primary bending and torsional stiffness. In addition, the number of cycles to failure in cyclic bending loading were determined and compared. Bone mineral density was measured in all specimens.ResultsBone mineral density was comparable in both groups. Primary stability was higher in the polyaxial-locking group under torsional loading, and higher in the non-locking group under bending loading. The differences, however, were not statistically significant. All specimens except for one fixed-angle construct failed the cyclic loading test. The number of cycles to failure did not differ significantly between polyaxial-locking and non-locking fixation.ConclusionIn a cadaveric Weber B fracture model, we observed no differences in biomechanical properties between polyaxial-locking and non-locking fixation using an antiglide plate. Based on the biomechanical considerations, no recommendation can be made regarding the choice of the implant. Further biomechanical and clinical studies are required.Clinical relevanceInformation on the behavior of polyaxial-locking plates is relevant to surgeons performing internal fixation of distal fibula fractures.