Abstract
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.