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Cost analysis and clinical outcomes of anatomic pre-contoured locking versus conventional plates for distal fibula ankle fractures

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

To analyze differences in union, complication rates and cost from surgical fixation of distal fibula fractures with fibular plating implants.

Methods

In total, 380 adult patients from 2012 to 2015 treated with 12 fibular plates from 4 different manufacturers utilized by 9 surgeons were retrospectively reviewed. They were stratified into a conventional one-third tubular fibular plate group, pre-contoured anatomic locking plate group, or a heterogeneous group including 3.5-mm reconstruction, one-third tubular locking, composite, and limited compression plates. The outcomes included failure of fixation, deep infection requiring debridement, time to union, anatomic reduction, superficial infection, hardware removal, and post-traumatic arthritis. Plate and screw costs were calculated from hospital billing records.

Results

Pre-contoured locking plates were used in older, female patients with a greater number of comorbidities. Open injuries and OTA 44B fractures were more likely to be an indication for pre-contoured plates. There was no difference noted in time to union between the different plating groups. Risk factors for deep infection requiring debridement included a history of tobacco use, open fractures, and pre-contoured locking plates relative to the conventional plating group. The pre-contoured plating group was on average $586 more expensive compared to the conventional group.

Conclusion

Pre-contoured locking plates achieved similar radiographic outcomes compared to conventional plates with an increased risk of complications and higher cost. Surgeons should consider their choice of implant based on the patient’s fracture pattern, underlying comorbidities, and risk for infection.

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Funding

The authors did not receive support from any organization for the submitted work. No funding was received to assist with the preparation of this manuscript. No funding was received for conducting this study. No funds, grants, or other support was received.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of South Florida, 5 Tampa General Circle, HMT 710, Tampa, FL, 33606, USA

    Raahil Patel, Kevin McCarthy, Joseph Christensen, Bonamico Jacobs, Jordan Karsch, Andrew Sephien, Christopher Matson, Roy W. Sanders & Hassan Riaz Mir

  2. Florida Orthopaedic Institute, 13020 N Telecom Parkway, Tampa, FL, 33637, USA

    Roy W. Sanders & Hassan Riaz Mir

Authors
  1. Raahil Patel
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  2. Kevin McCarthy
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  3. Joseph Christensen
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  4. Bonamico Jacobs
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  6. Andrew Sephien
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  7. Christopher Matson
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  8. Roy W. Sanders
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  9. Hassan Riaz Mir
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Contributions

RP, KM, JC, JK, AS, BJ, and CM all contributed to the conception and design of the study, data collection and analysis, manuscript writing and editing. RWS and HRM were essential toward the mentorship required for this manuscript.

Corresponding author

Correspondence to Raahil Patel.

Ethics declarations

Conflict of interest

The authors have no relevant financial or non-financial interests to disclose. The authors have no competing interests to declare that are relevant to the content of this article. All data collected were stored in secure stations with all patient health information anonymized for added security. Research involving human participants and/or animals was not applicable. Informed consent in the manuscript was not applicable. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript. The authors have no financial or proprietary interests in any material discussed in this article.

Ethical approval

This manuscript was classified as “exempt” from institutional review board approval due to the minimal risk surrounding our retrospective review. All data collected were stored in secure stations with all patient health information anonymized for added security. Research involving human participants and/or animals was not applicable. Informed consent in the manuscript was not applicable.

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Patel, R., McCarthy, K., Christensen, J. et al. Cost analysis and clinical outcomes of anatomic pre-contoured locking versus conventional plates for distal fibula ankle fractures. Eur J Orthop Surg Traumatol 34, 959–965 (2024). https://doi.org/10.1007/s00590-023-03728-2

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  • DOI: https://doi.org/10.1007/s00590-023-03728-2

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