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Ankle Frx: Plate Position and Application

- See: Antiglide Plate

- Discussion:
    - position of plate is dependent on level of frx, condition of overlying soft tissues, and the extent of comminution;

- Posteriorly Positioned Plate:
    - see antiglide plate:
    - allows use of a thicker, stronger plate;
    - less risk of wound slough;
    - irritate peroneal tendons;
    - distal screws obtain better purchase, since they engage a thicker part of distal fibula, and engage 2 cortices without risk of joint penetration;
    - posterior plate will not allow a syndesmotic screw to pass thru 1/3 tubular plate;

- Laterally Positioned Plate:
    - 1/3 tubular plate conforms to the curvature of the fibula and has a lower profile than the thicker compresssion plates;
    - Plate Contouring:
            - distal fibula also has a lateral bow, which should be restored as part of an anatomic reduction;
            - plate must be contoured to accommaodate this bow to prevent medial displacement of frx or excessive compression of Mortise;
    - plate is fixed w/ 3.5 mm cortical screws;
    - it is usually possible to place 2 or 3 screws distal to frx and 3 screws proximal to the fracture;
    - distal screws should engage the medial cortex of the fibula but not protrude into the fibulotalar joint