TY - JOUR
T1 - The Fracture Ankle Implant Review (FAIR) study : a national multicentre retrospective review of practice in implant choice, fixation methods, and outcomes in fixation of the fibula in ankle fractures
AU - Fishley, William G.
AU - Baldock, Thomas
AU - Hilley, Alan J.
AU - Morrison, Rory
AU - Baker, Paul
AU - Townshend, Dave
AU - FAIR Study Collaborating Authors
AU - Imam, Mohamed
AU - Antonios, Tony
AU - Shahid, Zuhaib
AU - Luck, Joshua
AU - Kent, Jonathan
AU - Crowther, Ian
AU - Mazur, Karolina
AU - Barwick, Thomas
AU - Al-Musawi, Hashim
AU - Adesina, Temitope Simon
AU - Dhinsa, Bal
AU - Garcia, Sean M. A.
AU - Maatough, Annis
AU - Kantak, Avadhoot P.
AU - Lal, Aayush
AU - Shammeseldin, Eltayeb
AU - Madeley, N. Jane
AU - Warwick, Catherine
AU - Paterson, Angus
AU - Gould, Anthony
AU - Brown, Robyn
AU - Stamatpoulos, Alexandros
AU - Boddu, Krishna
AU - Chrastek, David
AU - Gopinath, Praveen
AU - Giannoudis, Peter
AU - Rizwi, Hira
AU - Asaju, Ayobami
AU - Ellacott, Maximilian
AU - Samaullah, Aabid
AU - Heidari, Armirohammad
AU - Ditta, Adeel
AU - Bhattia, Chandra
AU - Griffiths, Alex
AU - Guiot, Luke
AU - Rohman, Adam
AU - Kovarik, Petr
AU - Koҫ, Togay
AU - Hardie, John
AU - Al-Kharouf, Khaled
AU - Chakravarthy, Jagannath
AU - Neo, Chryssa
AU - Gray, Matthew
PY - 2025/7
Y1 - 2025/7
N2 - AimsIn fixation of the fibula in ankle fractures, the AO Foundation advocates using a lag screw and one-third tubular neutralization plate for simple patterns. Where a lag screw cannot be placed, bridging fixation is required. A local pilot service evaluation previously identified variance in use of locking plates in all patterns with significant cost implications. The Fracture Ankle Implant Review (FAIR) study aimed to evaluate current practice and implant use across the UK, and review outcomes and complication rates between different fibula fixation methods.MethodsThe study was supported by CORNET, the North East orthopaedic trainee research collaborative, and the British Orthopaedic Trainee Association (BOTA). Data were collected using REDCap software from 22 centres in the UK retrospectively for a one-year period between 1 January 2019 and 31 December 2019 on injury mechanism, fracture characteristics, comorbidities, fixation, and complications. Follow-up data were collected to at least two years from surgery.ResultsA total of 1,471 ankle fractures which involved fixation of the fibula were analyzed; a one-third tubular plate was used in 883 cases (59.7%), a locking plate in 470 cases (31.8%), and other methods in 118 cases (8.1%). There was significant difference between centres (p < 0.001) in terms of the implant type which was used. Other factors associated with implant type were age, diabetes, osteoporosis, open fractures, and comminuted fractures. Incidence of lateral wound breakdown and infection was higher in locking plates than one-third tubular plates (Lateral wound breakdown p = 0.008, Infection p = 0.039) in AO44B fractures. There was no significant difference in nonunion, fixation failure, or removal of metalware.ConclusionThere is significant variation in practice in the UK in implant use for fixation of the fibula in ankle fractures. If a locking plate is used unnecessarily, where a one-third tubular shows equivalent outcomes, this incurs additional cost and may increase the risk of lateral wound complications. We would encourage surgeons with high locking plate usage to evaluate their own unit’s practice against these data.
AB - AimsIn fixation of the fibula in ankle fractures, the AO Foundation advocates using a lag screw and one-third tubular neutralization plate for simple patterns. Where a lag screw cannot be placed, bridging fixation is required. A local pilot service evaluation previously identified variance in use of locking plates in all patterns with significant cost implications. The Fracture Ankle Implant Review (FAIR) study aimed to evaluate current practice and implant use across the UK, and review outcomes and complication rates between different fibula fixation methods.MethodsThe study was supported by CORNET, the North East orthopaedic trainee research collaborative, and the British Orthopaedic Trainee Association (BOTA). Data were collected using REDCap software from 22 centres in the UK retrospectively for a one-year period between 1 January 2019 and 31 December 2019 on injury mechanism, fracture characteristics, comorbidities, fixation, and complications. Follow-up data were collected to at least two years from surgery.ResultsA total of 1,471 ankle fractures which involved fixation of the fibula were analyzed; a one-third tubular plate was used in 883 cases (59.7%), a locking plate in 470 cases (31.8%), and other methods in 118 cases (8.1%). There was significant difference between centres (p < 0.001) in terms of the implant type which was used. Other factors associated with implant type were age, diabetes, osteoporosis, open fractures, and comminuted fractures. Incidence of lateral wound breakdown and infection was higher in locking plates than one-third tubular plates (Lateral wound breakdown p = 0.008, Infection p = 0.039) in AO44B fractures. There was no significant difference in nonunion, fixation failure, or removal of metalware.ConclusionThere is significant variation in practice in the UK in implant use for fixation of the fibula in ankle fractures. If a locking plate is used unnecessarily, where a one-third tubular shows equivalent outcomes, this incurs additional cost and may increase the risk of lateral wound complications. We would encourage surgeons with high locking plate usage to evaluate their own unit’s practice against these data.
KW - Ankle fracture
KW - Fixation
KW - Infection
KW - Locking plate
KW - Locking plates
KW - One-third tubular plate
KW - comorbidities
KW - diabetes
KW - fibula
KW - locking plate fixation
KW - osteoporotic bone
KW - wound
KW - wound complications
UR - https://www.scopus.com/pages/publications/105012022638
U2 - 10.1302/2633-1462.67.BJO-2025-0009.R1
DO - 10.1302/2633-1462.67.BJO-2025-0009.R1
M3 - Article
C2 - 40675589
SN - 2633-1462
VL - 6
SP - 841
EP - 849
JO - Bone & Joint Open
JF - Bone & Joint Open
IS - 7
ER -
