Posterior versus Lateral Plate Fixation of Short Oblique Fractures of the Distal Fibula: A Literature Review

Background: Oblique spiral fractures of the distal third of the fibula are commonly encountered in any orthopedic practice. Controversy persists over various fixation methods and their corresponding risks and benefits. Methods: A systematic review of the pertinent literature pertaining to these fractures was performed, and currently published results were summarized. Results: There are advantages and disadvantages to each fixation method. Supporters of direct lateral plating argue for less peroneal irritation, ease of exposure, and direct fracture reduction. Those in favor of posterior plating report increased biomechanical strength, less lateral skin irritation, infrequent need for hardware removal, and ability to use bicortical fixation in the distal fragment. Modern implant advances and minimally invasive approaches have added complexity to fixation choices. Conclusion: Presently there is insufficient evidence to support either posterior or lateral fibular plating as a gold standard. Choice of approach and surgical technique should be individually based on fracture pattern, patient characteristics and surgeon experience.