Posterior plating of displaced Weber B fibula fractures

This is a prospective study that examines 32 patients who were treated with posterior plating of a displaced Weber B fibula fracture and had a minimum of 1 year follow-up. The surgical technique included application of an unbent one-third tubular plate to the posterior aspect of the fibula using the antiglide technique. Twenty-seven fractures were classified as supination-eversion IV: 13 with deltoid disruption and 14 with a medial malleolar fracture. Three were classified as pronation-abduction and two as low pronation-eversion fractures at the level of the plafond. A six-hole plate was used most often (18 cases), and 23 patients had a lag screw placed through the plate. There were no nonunions or malunions. No wound complications, screw loosening, loss of fixation, intraarticular screws, or palpable screws were found. Four patients had transient peroneal tendinitis that resolved in 4-8 weeks. Two patients had later plate removal caused by poor technique because of a symptomatic lag screw. Twenty of the 21 patients who returned a questionnaire were satisfied with their result (95%). Posterior fibular plating offers many advantages over lateral plating, including the possibility of no intraarticular or palpable screws and an improved and stronger distal fixation construct. Our favorable results suggest that this technique should be given consideration as a treatment of choice for displaced Weber B fibula fractures.