SLR - October 2015 - Jeeten Singha

Prospective Randomized Comparison of Locked Plates Versus Nonlocked Plates for the Treatment of High-Energy Pilon Fractures

Reference: d’Heurle A, Kazemi N, Connelly C, Wyrick JD, Archdeacon MT, Le TT. Prospective Randomized Comparison of Locked Plates Versus Nonlocked Plates for the Treatment of High-Energy Pilon Fractures. J Orthop Trauma. 2015 Sep; 29 (9): 420–423.

Scientific Literature Review

Reviewed By: Jeeten Singha, DPM
Residency Program: The Mount Sinai Hospital, Icahn School of Medicine, New York, NY.  

Podiatric Relevance: With a growing number of podiatric surgeons performing reconstructive foot and ankle surgeries, many will encounter high-energy pilon fractures of the ankle. Literature states there are several advantages of a locking screw/plate system versus conventional non-locking systems. A locking system allows for the screw to lock itself to the plate to stabilize the fragments without needing for the plate to come in intimate contact with bone. Other advantages include: screws unlikely to back out of plate, less disruption of cortical bone perfusion, and possibly more stable fixation. This study compared the radiographic and functional outcome of patients with pilon fractures treated with locked vs. non-locked plates/screw systems.

Methods: This was a retrospective analysis of 60 patients with 62 AO/OTA type A, B and C, tibial pilon fractures. Thirty-two patients were fixed with locking plating system and 29 patients were treated with non-locking plating system. Follow up data was available for 33 out of the 60 patients. Functional outcomes were assessed using Short Musculoskeletal Function Assessment (SFMA) and AOFAS Ankle Hindfoot Score (AHFS). Radiographic outcomes were assessed with measurement of angulations of the tibia relative to the talus in coronal and sagittal planes, immediately post-operative and latest follow-up visit. A change of greater than 5 degrees was considered loss of reduction. The average radiographic follow-up was 35.6 months.

Results: A total of 60 patients (62 fractures) were enrolled initially, but follow-up data was available for only 33 patients. There were nine patients in the locking plate group and 12 patients in non-locking group with AHFS mean of 64.7 and 73.5, SMFA mean of 36 and 27.3 in the respected groups. Both groups had similar rates of complications including non-union, malunion, infection, implant failure and painful implant.  

Conclusions: There was no statistical difference found between locking vs non-locking plates to fixate pilon fractures in this study. No difference was found in both long-term radiographic outcomes and comparing functional outcome scores. This study was limited in the percentage of patients available for final follow-up. Choosing between a locking vs. non-locking construct for a pilon fracture must be based on the unique fracture type of each patient and surgeon preference. 

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