Union rates of Weber B fibular fractures: A retrospective comparison of lateral locking plate fixation with and without interfragmentary lag screws

Open reduction and internal fixation (ORIF) is the standard treatment for Weber B fibular fractures to restore ankle stability. Traditionally, surgeons often use a lateral neutralization plate in combination with an interfragmentary lag screw to provide compression across the fracture site. However, the use of lag screws can be technically challenging in poor-quality bone and may risk injury to surrounding nerves or soft tissues. This retrospective study compared the clinical outcomes of two groups: patients treated with a lateral locking plate plus a lag screw, and those treated with a lateral locking plate alone.

The study reviewed 71 patients who underwent ORIF for Weber B fibular fractures. The researchers found no statistically significant differences between the two groups regarding the primary outcome of fracture union within 12 weeks (97.56% for the lag screw group versus 93.33% for the plate-only group). Furthermore, there were no significant differences in the average time to union (8.45 weeks versus 9.10 weeks) or the overall complication rates. The results suggest that for many patients, the mechanical stability provided by a modern locking plate is sufficient for healing, potentially rendering the additional lag screw unnecessary in certain clinical scenarios.

These findings provide evidence that surgeons have flexibility in their fixation strategy for Weber B fibular fractures. By demonstrating that plate-only fixation is a reliable alternative, this study supports a less invasive approach that may avoid the specific complications associated with lag screw placement, such as hardware prominence or damage to nearby cutaneous nerves. This is particularly relevant when bone quality is poor or when anatomical constraints make the placement of an interfragmentary screw difficult.