03/12/2010
AO Technical Commission Approved

2.7/3.5 mm LCP Posterolateral Distal Fibula

Treating unstable ankle fractures successfully requires anatomical reduction and stabilization of the distal fibula. This involves restoring accurate length, alignment, and rotation. Often this may be complicated by comminution, osteoporotic bone, and associated syndesmotic instability. Laterally-based-placed fibular plates do not allow for buttressing of the common posterior or posterolateral fracture spike of the distal fragment, and positioning of the plate is directly subcutaneous to the incision, which is often through thin or compromised skin. Using standard small fragment implants provides limited options for distal fixation.

The 2.7/3.5 mm LCP posterolateral distal fibula addresses these issues by offering a precontoured, thin but stronger plate which assists with anatomical reduction to restore joint congruency. It is indicated for fractures, osteotomies, and nonunions of the metaphyseal and diaphyseal region of the distal fibula, especially in osteopenic bone.

The LCP posterolateral distal fibula plate offers six round locking holes and two coaxial holes distally which accept 2.4 and 2.7 mm locking and cortex screws to provide multiple screw options. The distal holes are slightly divergent to help prevent screw pullout. The coaxial hole accepts both locking and cortex screws and its recess for screw heads minimizes screw-head prominence by allowing the screws to sit more flush with the plate, creating a low-profile construct. Its posterolateral position allows it to be placed deep to the peroneal muscles, minimizing the risk of wound healing problems due to prominence. A 2.7 mm lag screw may be placed through the distal screw cluster, and a syndesmotic screw may also be placed through the plate.

The anatomically precontoured plate shaft is only 2.25 mm thick yet substantially stronger than the one-third tubular plate. The combination holes in the shaft accept 3.5 mm locking screws, 3.5 mm cortex screws, and 4.0 mm cancellous bone screws.

The plate comes in left and right versions and is available in lengths from 77233 mm (3, 4, 5, 6, 7, 9, 11, 13, and 15 holes). It is offered in stainless steel and titanium, sterile, and nonsterile.

Case provided by Michael J Gardner, St Louis, USA.

A 56-year-old man slipped and fell, sustaining a fracture dislocation of the ankle. His fibula was stabilized with a posterolateral plate. The construct included several nonlocking screws in the diaphysis, and multiple 2.7 mm locking screws in the distal fibula. As with most Weber B fracture patterns, a lag screw was possible from posterior to anterior through the plate. Finally, intraoperatively the patient was found to have a syndesmotic injury, and after reduction, a syndesmotic screw was placed through the plate.

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