Functional outcome in mini-fragment plating of the fibula in unstable ankle fractures.

PURPOSE: Ankle fractures are common fractures, usually involving the fibula. Standard treatment with small-fragment (3.5 mm) plates is associated with wound complications and implant removal, prompting interest in mini-fragment plates (2.7/2.8 mm). This study evaluated functional outcomes, complication rates, and revision surgery following open reduction and internal fixation (ORIF) with mini-fragment implants, and compared results with published data on small-fragment plating.

METHODS

A retrospective review was conducted in a Dutch Level-1 trauma center (2015-2025). Patients aged 18-75 years with fibular fracture fixation and ≥ 12 months follow-up were included. Outcomes included surgical site infection (SSI), revision surgery, and functional outcome scores (AOFAS score, OMAS, VAS of pain, and Overall patient satisfaction score). Regression analysis identified predictors of outcome.

RESULTS

Among 144 eligible patients, 116 received a mini-fragment plate. SSI occurred in 4.3%, revision rate 2.6%, and implant removal in 10.3% of cases. The median AOFAS score was 85, OMAS 65, VAS of pain 1, and overall satisfaction score 8. BMI and prolonged surgical duration negatively impacted AOFAS scores. Weber C fractures were associated with worse VAS of pain, while higher BMI and open fractures showed a paradoxical positive effect. ASA 3/4 score and open fractures were significant predictors for SSI. No significant predictors were identified for OMAS or overall patient satisfaction score.

CONCLUSION

Mini-fragment fixation (2.7/2.8 mm) for unstable ankle fractures is a safe and effective alternative to small-fragment plating, with similar or lower complication and implant removal rates and functional outcome. These findings support the safe use of mini-fragment implants.