title: A biomechanical comparison of one-third tubular plates versus periarticular plates for fixation of osteoporotic distal fibula fractures.
abstract: OBJECTIVE
  The purpose of this study was to test the biomechanical properties of locking and nonlocking plates using one-third tubular and periarticular plate designs in an osteoporotic distal fibula fracture model.
  
  
  METHODS
  Twenty-four cadaveric specimens, whose bone mineral densities were obtained using dual x-ray absorptiometry scans, were tested. The fracture model simulated an OTA 44-B2.1 fracture. The constructs included (1) nonlocking one-third tubular plate, (2) locking one-third tubular plate, (3) nonlocking periarticular plate, and (4) locking periarticular plate. The specimens underwent axial loading followed by torsional loading to failure. Statistical analysis was performed using Kruskal-Wallis testing and further analysis with Mann-Whitney testing.
  
  
  RESULTS
  The periarticular plates had greater rotational stiffness compared with the one-third tubular plates (P = 0.04). The nonlocking plates had greater torque to failure than the locking plates (P = 0.01). The nonlocking one-third tubular plate had greater torque to failure than the locking one-third tubular plate (P = 0.03). No significant differences were found in any of the comparisons regarding axial stiffness.
  
  
  CONCLUSIONS
  In biomechanical testing using an osteoporotic model of OTA 44-B2.1 fractures, periarticular plates were superior to one-third tubular plates in rotational stiffness only. Locking plates did not outperform their nonlocking counterparts. Periarticular plates should be considered when treating osteoporotic distal fibula fractures, but one-third tubular plates and nonlocking plates provide adequate fixation for these injuries.
authors.affiliation: Department of Orthopaedic Surgery, Saint Louis University, St Louis, MO 63110, USA.
authors.forename: Adrian T
authors.initials: AT
authors.lastname: Davis
authors.forename: Heidi
authors.initials: H
authors.lastname: Israel
authors.forename: Lisa K
authors.initials: LK
authors.lastname: Cannada
authors.forename: J Gary
authors.initials: JG
authors.lastname: Bledsoe
mesh_terms: D015502:Absorptiometry, Photon; D001696:Biomechanical Phenomena; D015519:Bone Density; D001860:Bone Plates / Q000145:classification*; D002102:Cadaver; D004867:Equipment Design; D005360:Fibula / Q000293:injuries* / Q000601:surgery; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods; D050723:Fractures, Bone / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D008422:Materials Testing; D008953:Models, Anatomic; D010024:Osteoporosis / Q000150:complications*