title: A contoured locking plate for distal fibular fractures in osteoporotic bone: a biomechanical cadaver study.
abstract: OBJECTIVE
  Fixation of ankle fractures in elderly patients is associated with reduced stability conditioned by osteoporotic bone. Therefore, fixation with implants providing improved biomechanical features could allow a more functional treatment, diminish implant failure and avoid consequences of immobilisation.
  
  
  METHODS
  In the actual study, we evaluated a lateral conventional contoured plate with a locking contoured plate stabilising experimentally induced distal fibular fractures in human cadavers from elderly. Ankle fractures were induced by the supination-external rotation mechanism according to Lauge-Hansen. Stage II fractures (AO 44-B1) were fixed with the 2 contoured plates and a torque to failure test was performed. Bone mineral density (BMD) was measured by quantitative computed tomography to correlate the parameters of the biomechanical experiments with bone quality.
  
  
  RESULTS
  The locking plate showed a higher torque to failure, angle at failure, and maximal torque compared to the conventional plate. In contrast to the nonlocking system, fixation with the locking plate was independent of BMD.
  
  
  CONCLUSIONS
  Fixation of distal fibular fractures in osteoporotic bone with the contoured locking plate may be advantageous as compared to the nonlocking contoured plate. The locking plate with improved biomechanical attributes may allow a more functional treatment, reduce complications and consequences of immobilisation.
authors.affiliation: University Hospital of Wuerzburg, Department of Trauma, Hand-, Plastic- & Reconstructive Surgery, Oberduerrbacher Str. 6, 97080 Wuerzburg, Germany. zahn_r@chirurgie.uni-wuerzburg.de
authors.forename: Robert Karl
authors.initials: RK
authors.lastname: Zahn
authors.forename: Soenke
authors.initials: S
authors.lastname: Frey
authors.forename: Rafael Gregor
authors.initials: RG
authors.lastname: Jakubietz
authors.forename: Michael Georg
authors.initials: MG
authors.lastname: Jakubietz
authors.forename: Stefanie
authors.initials: S
authors.lastname: Doht
authors.forename: Peter
authors.initials: P
authors.lastname: Schneider
authors.forename: Jens
authors.initials: J
authors.lastname: Waschke
authors.forename: Rainer Heribert
authors.initials: RH
authors.lastname: Meffert
mesh_terms: D000368:Aged; D001696:Biomechanical Phenomena; D015519:Bone Density; D001860:Bone Plates; D002102:Cadaver; D005260:Female; D005360:Fibula / Q000293:injuries / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000379:methods; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D008297:Male; D008953:Models, Anatomic; D010024:Osteoporosis / Q000150:complications / Q000601:surgery*