Early results of proximally inserted minimally invasive plate osteosynthesis for distal fibular fractures in unfavorable skin conditions: A case series

Background:Operative fixation of fractures of the lateral malleolus may be complicated by skin complications and wound infection, especially in patients with an unfavorable skin condition or soft-tissue injury. The goal of this study was to assess a technique of minimally invasive, proximally inserted plate fixation for distal fibular fractures in unfavorable skin conditions, including superficial abrasions, blisters, and contusions.Methods:This prospective case series study included 20 patients with syndesmotic and suprasyndesmotic fractures of the distal fibula, with unfavorable skin conditions, presenting to the emergency department of a major trauma center between May, 2015 and May, 2016. All patients were followed for an average of 1 yr (range, 6 mo-2 yr).Results:All fractures united at an average of 9.4 wk (range, 8-12 wk). Functional assessment according to the American Orthopaedic Foot And Ankle Society Scoring system was 93.9 (range, 78-100). None of the cases was complicated by wound dehiscence or deep infection.Conclusions:Minimally invasive, proximally inserted plate fixation is a viable and safe technique that can avoid an incision over the skin of the distal fibula in patients with unfavorable skin conditions.Level of Evidence:Level IV.