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Increased stiffness
7%
132/1810
Increased strength
6%
110/1810
Decreased rate of hardware prominence
105/1810
Increased risk of intra-articular screw penetration
63%
1141/1810
Increased peroneal tendinitis
17%
315/1810
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Lateral plating of the distal fibula has an increased risk of intra-articular screw penetration with the trajectory of the screws distally; bicortical screws will be intra-articular in nature, whereas posterior plating screws will exit anteriorly. Figure A shows an antiglide (posterior) plating of the distal fibula, while Figure B shows a lateral neutralization plating of the distal fibula. Both methods are acceptable, but posterior antiglide plating is associated with increased construct stiffness and strength, decreased hardware prominence, decreased rates of ankle joint screw penetration, and improved biomechanical findings in osteoporotic bone. However, posterior plating is associated with an increased rate of peroneal tendonitis and irritation. Illustration A shows a lateral radiograph of a posterior fibular plate. The referenced article by Ostrum et al is a case series of 32 patients who had antiglide plating; he reported a 100% union rate, 95% patient satisfaction rate, and only 4/32 reported peroneal tendinitis, with all resolving by 2 months. The other referenced article by Schaffer et al reported that the posterolateral antiglide plate demonstrated improved biomechanical stability as compared to the lateral plating, with increased construct stiffness and load to failure.
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