Journal of Foot and Ankle Surgery - 2026-03-10 - Journal Article
Union rates of Weber B fibular fractures: A retrospective comparison of lateral locking plate fixation with and without interfragmentary lag screws.
Tavakoli PP, Vyas PB, Huntsman K, Duffin E, Brancheau P
Topics
Key Takeaway
Lateral locking plate fixation without a lag screw achieved 93.33% union within 12 weeks for Weber B fibular fractures, not significantly different from the 97.56% union rate with plate-plus-lag-screw fixation (p=0.38).
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Summary
This single-institution retrospective study compared union rates of Weber B fibular fractures fixed with lateral locking plate plus interfragmentary lag screw versus plate alone in 71 patients with minimum 12-month follow-up. Union within 12 weeks was 97.56% (plate+lag screw) vs 93.33% (plate-only), p=0.38; time to union was 8.45 vs 9.10 weeks, p=0.23; complication rates were also not significantly different (p=0.76). Plate-only fixation was a statistically equivalent alternative when lag screw placement is not feasible.
Key Limitation
The absence of documented surgeon rationale for lag screw omission means the plate-only group may represent systematically different fracture morphologies, making the two groups potentially non-comparable despite similar reported union rates.
Original Abstract
BACKGROUND
Plate fixation with an interfragmentary lag screw is often used for Weber B fibular fractures. However, consensus is lacking regarding whether lateral locking plate fixation without a lag screw is also a viable option for Weber B fractures.
PURPOSE
Compare union rates of Weber B fibular fractures fixated using a lateral locking plate and lag screw versus a lateral locking plate-only.
STUDY DESIGN
Retrospective cohort study.
METHODS
A retrospective review was conducted on patients who underwent ankle open reduction internal fixation (ORIF) at a single institution between 01/01/2022 and 01/01/2024. Patients had a minimum of a 12 month follow-up. Primary outcome measured included fracture union within 12 weeks which was defined as radiographic evidence of bridging callus across the fracture site with resolution of fracture line, painless weightbearing, and minimal or no tenderness on palpation over the fracture site. Secondary outcomes included time to union and complication rates.
RESULTS
Seventy-one patients were included, 41 of which were treated with a plate and lag screw, and 30 with a plate-only. There was no significant difference in union rates (plate + lag screw: 97.56% vs plate-only 93.33%, p = 0.38) or time to union (plate + lag screw: 8.45 weeks vs plate-only 9.10 weeks, p = 0.23). The plate-only group showed a slightly lower complication rate, although not statistically significant (p = 0.76).
CONCLUSION
With no significant differences observed in union rates, time to union, or complication rates, plate-only fixation seems to be a reliable alternative when insertion of an interfragmentary lag screw may not be feasible.