title: Buttress Plating Versus Anterior-to-Posterior Lag Screws for Fixation of the Posterior Malleolus: A Biomechanical Study.
abstract: OBJECTIVE
  The preferred method of fixation for posterior malleolus fractures remains controversial, and practices vary widely among surgeons. The purpose of this study was to compare anterior-to-posterior (AP) lag screws with posterior buttress plating for fixation of posterior malleolus fractures in a human cadaveric model.
  
  
  METHODS
  Posterior malleolus fractures involving 30% of the distal tibial articular surface were created in 7 pairs of fresh frozen cadaveric ankles. One specimen in each pair was randomly assigned to fixation with either 2 AP lag screws or a one-third tubular buttress plate without supplemental lag screws. Each specimen was then subjected to cyclic loading from 0% to 50% of body weight for 5000 cycles followed by loading to failure. Outcome measures included permanent axial displacement during each test cycle (axial displacement at no load), peak axial displacement during each test cycle (axial displacement at 50% body weight), load at 1-mm axial displacement, ultimate load, and axial displacement at ultimate load.
  
  
  RESULTS
  The buttress plate group showed significantly less peak axial displacement at all time points during cyclic loading. Permanent axial displacement was significantly less in the buttress plate group beginning at cycle 200. There were no significant differences between the 2 groups during load-to-failure testing.
  
  
  CONCLUSIONS
  Posterior malleolus fractures treated with posterior buttress plating showed significantly less displacement during cyclical loading compared with fractures fixed with AP lag screws. Surgeons should consider these findings when selecting a fixation strategy for these common fractures. Further research is warranted to investigate the clinical implications of these biomechanical findings.
authors.affiliation: *Department of Orthopaedic Surgery, Stanford University Medical Center, Redwood City, CA; †Department of Orthopaedic Surgery, Harborview Medical Center, Seattle, WA; and ‡OrthoIndy at St.Vincent Indianapolis, Indianapolis, IN.
authors.forename: Chase
authors.initials: C
authors.lastname: Bennett
authors.forename: Anthony
authors.initials: A
authors.lastname: Behn
authors.forename: Adam
authors.initials: A
authors.lastname: Daoud
authors.forename: Sean
authors.initials: S
authors.lastname: Nork
authors.forename: Bruce
authors.initials: B
authors.lastname: Sangeorzan
authors.forename: Gregory
authors.initials: G
authors.lastname: Dikos
authors.forename: Julius
authors.initials: J
authors.lastname: Bishop
mesh_terms: D000328:Adult; D000368:Aged; D064386:Ankle Fractures / Q000503:physiopathology* / Q000601:surgery*; D001860:Bone Plates; D001863:Bone Screws; D002102:Cadaver; D019245:Compressive Strength; D019544:Equipment Failure Analysis; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009038:Motion; D010865:Pilot Projects; D011474:Prosthesis Design; D013314:Stress, Mechanical; D013639:Tarsal Bones / Q000293:injuries / Q000503:physiopathology* / Q000601:surgery; D013718:Tensile Strength; D016896:Treatment Outcome