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OTA 2013: Locking plates comparable to nonlocking plates for high-energy pilon fracture
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February 2025
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Synopsis
58 patients with high-energy pilon fractures were randomized to evaluate the efficacy of locking plates against convention nonlocking plates, over 1 year. Radiographic data was evaluated for loss of reduction using Mortise/ AP and lateral radiographs of the ankle, and functional outcomes were assessed using ankle hindfoot scores, and Short Musculoskeletal Function Assessment (SMFA). The evidence presented in this study demonstrates that both treatments perform comparably in each outcome measurement, but the authors of the study indicate that the results may suffer from type II error due to the low incidence of reduction loss.
Why was this study needed now?
High-energy pilon fractures are conventionally treated with nonlocking plates. This study was needed to evaluate and compare the clinical and radiographic outcomes associated with the use of locking plates against nonlocking plates for the management of high-energy pilon fractures.
What was the principal research question?
Do locking plates present comparable clinical and radiographic outcomes to nonlocking plates for the treatment of high-energy pilon fractures, assessed over 1 year?
Study Characteristics
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Population:
58 patients with high-energy pilon fractures. Radiographic measurements for 33 patients (34 fractures) were assessed within 6 months, and 18 patients (31%) were available for functional outcome assessments.
Intervention:
Lock Group: Patient fracture managed using locking plates (n= 15)
Comparison:
Nonlock Group: Patients administered nonlocking plates for fracture treatment (n= 19)
Outcomes:
Loss of reduction assessed using Mortise/ AP and lateral radiographs of the ankle (angle measurement change >/= 5 degrees). Patients were also evaluated using ankle hindfoot scores, and Short Musculoskeletal Function Assessment (SMFA) functional outcome scores.
Methods:
RCT: Single-Centered
Time:
Patient functional outcomes assessed within 1 year. Radiographs conducted within 6 months.
What were the important findings?
- 2 of 15 (13%) of the fractures in the nonlocking group demonstrated loss of reduction >5 degrees, compared to 3 of 19 (16%) in the lock group (p= 0.999)
- No soft-tissue complications requiring surgical intervention were observed
- 1 patient in the lock group presented with deep infection, 2 with nonunions, and 2 with hardware failures. 1 patient in the nonlock group presented with hardware failure and 1 infected nonunion
- Average follow-up in 8 patients in the lock group, and 10 in the nonlock group, was reported at 35.6 SD 16.0 months.
- No significant differences between the lock and nonlock groups for ankle hindfoot scores: 71.75 SD 71.75 versus 66.1 SD 23.8 respectively (p= 0.625)
- No significant difference between groups was apparent for SMFA-BI (bother index) scores with 7175 SD 25.4 in the lock group compared to 66.1 SD 23.8 in the nonlock group (p= 0.625)
- SMFA-FI (function index) analysis between the lock and nonlock groups revealed no significant difference with a score of 32.9 SD 36.2 in the lock group compared to 25.7 SD 20.2 in the nonlock group (p= 0.587)
What should I remember most?
Both the locking plate and the nonlocking plates performed comparably for all evaluated outcomes: loss of reduction and radiologic analyses.
How will this affect the care of my patients?
The evidence presented in this study demonstrates that both locking and nonlocking plates are comparable interventions for high-energy pilon fractures. The results presented in this study may be subject to type II error as indicated by the low incidence of reduction loss.
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