• Florian Hess and Christoph Sommer.
• Department of Surgery, Trauma Unit, Kantonsspital Graubünden, Chur.
• J Orthop Trauma. 2011 Feb 1; 25 (2): 110-5.

ObjectivesThe aim of this study was to evaluate the clinical feasibility and the possible complications associated with minimally invasive plate osteosynthesis of the distal fibula.Design/SettingRegional county hospital.Patients/ParticipantsAll patients with Orthopaedic Trauma Association 42, 43, 44 fractures of the distal tibia requiring plate fixation of the distal fibula were included in this cohort study. A consecutive series of 701 internally fixed fractures of tibia and ankle yielded 20 fibular fractures treated with this technique.InterventionFractures were treated with the minimally invasive plate osteosynthesis technique using an angular stable screw-plate system for the fibula.Main Outcome MeasurementsClinical and radiologic outcomes at 24 months.ResultsSeventeen fractures healed without complication at an average of 9 weeks. Three aseptic nonunions were recorded: one in a pilon fracture (Orthopaedic Trauma Association 43-C3) and one in a distal lower leg fracture (Orthopaedic Trauma Association 43-A3), both with severe closed soft tissue injury (as a result of a crush mechanism). The third one was in an ankle fracture dislocation (OTA 44-C1) with delayed treatment and inadequate reduction of the simple fibula fracture.ConclusionAlthough this technique is comparable to minimally invasive plate osteosynthesis in the tibia or femur, it appears to be more difficult as a result of small bone size. As a result, we reserve this technique for selected complex fractures of the distal fibula with critical soft tissue conditions.

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