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, typically involving a lateral neutralization plate combined with an interfragmentary lag screw. While the lag screw provides compression, it can be technically challenging in osteoporotic bone or small-diameter fibulas and may risk injury to nearby nerves. This retrospective study compared the clinical outcomes of two groups: patients treated with a lateral locking plate plus a lag screw versus those treated with a lateral locking plate alone. The researchers analyzed 71 patients over a two-year period, evaluating union rates within 12 weeks, time to union, and complication rates.

The study found no statistically significant differences between the two fixation techniques. The union rate for the plate-plus-lag-screw group was 97.56%, compared to 93.33% for the plate-only group (p=0.38). Similarly, the average time to union was 8.45 weeks for the lag screw group and 9.10 weeks for the plate-only group (p=0.23). Complication rates, including hardware removal and infections, were also comparable between the two cohorts. These results suggest that the additional compression provided by a lag screw may not be strictly necessary for achieving successful healing in these specific fracture patterns when a modern locking plate is used.

These findings suggest that surgeons have flexibility in their approach to Weber B fibular fractures. If a lag screw is difficult to place due to poor bone quality or anatomical constraints, a plate-only construct appears to be a reliable and effective alternative. By simplifying the surgical procedure, clinicians may reduce the risk of complications associated with lag screw placement, such as nerve injury or hardware prominence, without compromising the patient's recovery or bone healing outcomes.