{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T15:07:20Z","timestamp":1788793640830,"version":"build-2803163510"},"reference-count":65,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2022,12,2]],"date-time":"2022-12-02T00:00:00Z","timestamp":1669939200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>(1) Background: As age in western populations is rising, so too are fractures, e.g., of the distal fibula. The aim of this study was to find out whether a novel, minimally invasive intramedullary osteosynthesis technique for the treatment of distal fibula fractures in elderly patients results in not only a reduction of postoperative complications, but also a shorter hospitalization time, an improved clinical outcome, and preserved autonomy in geriatric trauma patients. (2) Methods: In this prospective study, the results following surgical treatment for distal fibula fractures in geriatric patients after using DePuy Synthes\u00ae one-third semitubular plate (Group I) or a minimally invasive intramedullary photodynamic Bone StabilizationSystem (IlluminOss\u00ae) (Group II) were compared at 6 weeks, 12 weeks, 6 months, and 1 year after initial treatment. (3) Results: Significant improvement regarding clinical outcome was shown in Group II 6 and 12 weeks after surgery. (4) Conclusions: Our study results demonstrate that the use of this new intramedullary stabilization system in combination with an immediate postoperative weight bearing seems to be a safe and stable treatment option for ankle fractures in geriatric patients, especially in the early stages of recovery.<\/jats:p>","DOI":"10.3390\/jcm11237178","type":"journal-article","created":{"date-parts":[[2022,12,5]],"date-time":"2022-12-05T06:29:09Z","timestamp":1670221749000},"page":"7178","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["A Prospective Randomized Study Comparing Functional Outcome in Distal Fibula Fractures between Conventional AO Semitubular Plating and Minimal Invasive Intramedullary \u201cPhotodynamic Bone Stabilisation\u201d"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9956-0619","authenticated-orcid":false,"given":"Michael","family":"Zyskowski","sequence":"first","affiliation":[{"name":"Department of Trauma Surgery, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6114-3281","authenticated-orcid":false,"given":"Markus","family":"Wurm","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederik","family":"Greve","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6797-0453","authenticated-orcid":false,"given":"Philipp","family":"Zehnder","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Pfl\u00fcger","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2764-4178","authenticated-orcid":false,"given":"Michael","family":"M\u00fcller","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Biberthaler","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chlodwig","family":"Kirchhoff","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,12,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1016\/j.injury.2006.04.130","article-title":"Epidemiology of adult fractures: A review","volume":"37","author":"Caesar","year":"2006","journal-title":"Injury"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"C72","DOI":"10.1016\/S0020-1383(00)80037-6","article-title":"A biomechanical enigma: Why are tibial fractures not more frequent in the elderly?","volume":"31","author":"Grutter","year":"2000","journal-title":"Injury"},{"key":"ref_3","first-page":"2420","article-title":"Ankle fractures in the elderly patient","volume":"10","author":"Crevoisier","year":"2014","journal-title":"Rev. Med. Suisse"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1097\/01.bot.0000177105.53708.a9","article-title":"Ankle fractures in the elderly: What you get depends on where you live and who you see","volume":"19","author":"Koval","year":"2005","journal-title":"J. Orthop. Trauma"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1016\/S8756-3282(02)00832-3","article-title":"Increasing number and incidence of low-trauma ankle fractures in elderly people: Finnish statistics during 1970\u20132000 and projections for the future","volume":"31","author":"Kannus","year":"2002","journal-title":"Bone"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1093\/gerona\/62.3.296","article-title":"Comorbidity in older adults: Nosology of impairment, diseases, and conditions","volume":"62","author":"Karlamangla","year":"2007","journal-title":"J. Gerontol. Ser. A"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1016\/S1083-7515(02)00162-6","article-title":"Complications of open reduction and internal fixation of ankle fractures","volume":"8","author":"Leyes","year":"2003","journal-title":"Foot Ankle Clin."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2451","DOI":"10.1007\/s00264-013-2109-9","article-title":"Locking versus non-locking neutralization plates for treatment of lateral malleolar fractures: A randomized controlled trial","volume":"37","author":"Tsukada","year":"2013","journal-title":"Int. Orthop."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1067","DOI":"10.1053\/j.jfas.2015.06.002","article-title":"A Specialized Fibular Locking Plate for Lateral Malleolar Fractures","volume":"54","author":"Yeo","year":"2015","journal-title":"J. Foot Ankle Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1007\/s10195-014-0320-0","article-title":"Intramedullary fixation of distal fibular fractures: A systematic review of clinical and functional outcomes","volume":"15","author":"Jain","year":"2014","journal-title":"J. Orthop. Traumatol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1053\/j.jfas.2018.08.033","article-title":"Unstable Ankle Fracture Fixation Using Locked Fibular Intramedullary Nail in High-Risk Patients","volume":"58","author":"Dabash","year":"2019","journal-title":"J. Foot Ankle Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1127","DOI":"10.1016\/j.injury.2015.03.029","article-title":"How long should patients be kept non-weight bearing after ankle fracture fixation? A survey of OTA and AOFAS members","volume":"46","author":"Swart","year":"2015","journal-title":"Injury"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"981","DOI":"10.3109\/17453678008990904","article-title":"Ankle Fractures: Supination-Eversion Fractures of Stage IV: Primary and Late Results of Operative and Non\u2014Operative Treatment AU\u2014Yde, Johannes","volume":"51","author":"Kristensen","year":"1980","journal-title":"Acta Orthop. Scand."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1302\/0301-620X.83B4.0830525","article-title":"Conservative versus operative treatment for displaced ankle fractures in patients over 55 years of age","volume":"83","author":"Makwana","year":"2001","journal-title":"J. Bone Jt. Surgery. Br."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1588","DOI":"10.1177\/1071100713496223","article-title":"Biomechanical Comparison of 4 Different Lateral Plate Constructs for Distal Fibula Fractures","volume":"34","author":"Eckel","year":"2013","journal-title":"Foot Ankle Int."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1053\/j.jfas.2006.09.009","article-title":"Fixation of Osteoporotic Distal Fibula Fractures: A Biomechanical Comparison of Locking Versus Conventional Plates","volume":"46","author":"Kim","year":"2007","journal-title":"J. Foot Ankle Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"243","DOI":"10.3113\/FAI.2009.0243","article-title":"Biomechanical Evaluation of Plate Osteosynthesis of Distal Fibula Fractures with Biodegradable Devices","volume":"30","author":"Klos","year":"2009","journal-title":"Foot Ankle Int."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1007\/s00264-006-0216-6","article-title":"Less is more: Lag screw only fixation of lateral malleolar fractures","volume":"31","author":"McKenna","year":"2006","journal-title":"Int. Orthop."},{"key":"ref_19","first-page":"e6552","article-title":"Osteoporotic Distal Fibula Fractures in the Elderly: How to Fix Them","volume":"12","author":"Sain","year":"2020","journal-title":"Cureus"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Zyskowski, M., Wurm, M., Greve, F., Pesch, S., von Matthey, F., Pfl\u00fcger, P., Cr\u00f6nlein, M., Biberthaler, P., and Kirchhoff, C. (2021). Is early full weight bearing safe following locking plate ORIF of distal fibula fractures?. BMC Musculoskelet. Disord., 22.","DOI":"10.1186\/s12891-021-04009-x"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/j.ijsu.2015.07.697","article-title":"Intrmedullary versus extramedullary fixation of lateral malleolus fractures","volume":"22","author":"Rehman","year":"2015","journal-title":"Int. J. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1248","DOI":"10.1302\/0301-620X.98B9.35837","article-title":"A prospective randomised controlled trial of the fibular nail versus standard open reduction and internal fixation for fixation of ankle fractures in elderly patients","volume":"98","author":"White","year":"2016","journal-title":"Bone Jt. J."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1016\/j.cpm.2017.12.008","article-title":"Intramedullary Nailing of Fibular Fractures","volume":"35","author":"Fleming","year":"2018","journal-title":"Clin. Podiatr. Med. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1177\/1938640018790082","article-title":"Cannulated Intramedullary Screw Fixation of Distal Fibular Fractures","volume":"12","author":"Ebraheim","year":"2018","journal-title":"Foot Ankle Sp\u00e9c."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1016\/j.fas.2017.04.015","article-title":"Intramedullary fixation of lateral malleolus using Fibula Rod System in ankle fractures in the elderly","volume":"24","author":"Challagundla","year":"2018","journal-title":"Foot Ankle Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1053\/j.jfas.2018.08.028","article-title":"Intramedullary Fixation Versus Plate Fixation of Distal Fibular Fractures: A Systematic Review and Meta-Analysis of Randomized Controlled Trials and Observational Studies","volume":"58","author":"Tas","year":"2019","journal-title":"J. Foot Ankle Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/j.fas.2017.08.008","article-title":"Lateral malleolus closed reduction and internal fixation with intramedullary fibular rod using minimal invasive approach for the treatment of ankle fractures","volume":"25","author":"Coifman","year":"2019","journal-title":"Foot Ankle Surg."},{"key":"ref_28","first-page":"10","article-title":"Shorter recovery can be achieved from using walking boot after operative treatment of an ankle fracture","volume":"7","author":"Amaha","year":"2016","journal-title":"Asia-Pac. J. Sport. Med. Arthrosc. Rehabil. Technol."},{"key":"ref_29","first-page":"273","article-title":"Protected early motion versus cast immobilization in postoperative management of ankle fractures","volume":"29","author":"Jaggears","year":"1994","journal-title":"Contemp. Orthop."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1097\/BOT.0000000000001268","article-title":"Immediate Weight-Bearing Protocol for the Determination of Ankle Stability in Patients with Isolated Distal Fibular Fractures","volume":"32","author":"Bonness","year":"2018","journal-title":"J. Orthop. Trauma"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/j.bone.2016.03.006","article-title":"Epidemiology of fractures in the United Kingdom 1988-2012: Variation with age, sex, geography, ethnicity and socioeconomic status","volume":"87","author":"Curtis","year":"2016","journal-title":"Bone"},{"key":"ref_32","first-page":"395","article-title":"Postoperative treatment of internally fixed ankle fractures: A prospective randomised study","volume":"78","author":"Meeuwis","year":"1996","journal-title":"J. Bone Jt. Surg. Br. Vol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"k5432","DOI":"10.1136\/bmj.k5432","article-title":"Three week versus six week immobilisation for stable Weber B type ankle fractures: Randomised, multicentre, non-inferiority clinical trial","volume":"364","author":"Kortekangas","year":"2019","journal-title":"BMJ"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1097\/01.btf.0000221100.31792.c2","article-title":"The Fibula Nail for Treatment of Ankle Fractures in Elderly and High Risk Patients","volume":"5","author":"Appleton","year":"2006","journal-title":"Tech. Foot Ankle Surg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1007\/s00068-018-1016-6","article-title":"Weight-bearing or non-weight-bearing after surgical treatment of ankle fractures: A multicenter randomized controlled trial","volume":"46","author":"Smeeing","year":"2018","journal-title":"Eur. J. Trauma Emerg. Surg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"S241","DOI":"10.1016\/j.otsr.2016.03.001","article-title":"Ankle fractures in the elderly: Treatment and results in 477 patients","volume":"102","author":"Desseaux","year":"2016","journal-title":"Orthop. Traumatol. Surg. Res."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"120","DOI":"10.3113\/FAI.2011.0120","article-title":"Outcomes of Ankle Fractures in Patients with Uncomplicated versus Complicated Diabetes","volume":"32","author":"Wukich","year":"2011","journal-title":"Foot Ankle Int."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"302","DOI":"10.3109\/17453678809149368","article-title":"Mobilization after operation of ankle fractures Good results of early motion and weight bearing","volume":"59","author":"Ahl","year":"1988","journal-title":"Acta Orthop. Scand."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1097\/01.bot.0000197701.96954.8c","article-title":"Functional treatment and early weightbearing after an ankle fracture: A prospective study","volume":"20","author":"Simanski","year":"2006","journal-title":"J. Orthop. Trauma"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1007\/s00113-016-0285-y","article-title":"Osteosynthesis of distal fibular fractures with IlluminOss: Video article","volume":"120","author":"Zyskowski","year":"2017","journal-title":"Unfallchirurg"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Weber, B.G., and Colton, C. (1991). Malleolar Fractures. Manual of Internal Fixation: Techniques Recommended by the AO-ASIF Group, Springer.","DOI":"10.1007\/978-3-662-02695-3_14"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1097\/00005131-199304000-00003","article-title":"Closed interlocking nailing of femoral shaft fractures: Assessment of technical complications and functional outcomes by comparison of a prospective database with retrospective review","volume":"7","author":"Benirschke","year":"1993","journal-title":"J. Orthop. Trauma"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1302\/0301-620X.73B1.1991783","article-title":"Conservative management or closed nailing for tibial shaft fractures. A randomised prospective trial","volume":"73","author":"Hooper","year":"1991","journal-title":"J. Bone Jt. Surg."},{"key":"ref_44","first-page":"604","article-title":"Intramedullary Nailing and Minimally Invasive Percutaneous Plate Osteosynthesis in Treatment of Displaced Clavicular Mid-shaft Fractures: A Prospective Study","volume":"158","author":"Yuan","year":"2019","journal-title":"Z. Orthop\u00e4die Und Unf."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"961","DOI":"10.1053\/j.jfas.2018.03.033","article-title":"Why Fibular Nailing Can Be an Efficient Treatment Strategy for AO Type 44-B Ankle Fractures in the Elderly","volume":"57","author":"Peeperkorn","year":"2018","journal-title":"J. Foot Ankle Surg."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1186\/s13018-016-0435-5","article-title":"A biomechanical comparison study of a modern fibular nail and distal fibular locking plate in AO\/OTA 44C2 ankle fractures","volume":"11","author":"Switaj","year":"2016","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/0021-9681(87)90171-8","article-title":"A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation","volume":"40","author":"Charlson","year":"1987","journal-title":"J. Chronic Dis."},{"key":"ref_48","unstructured":"(2018). Malleolar Segment. J. Orthop. Trauma, 32, 67."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"2473011421S00117","DOI":"10.1177\/2473011421S00117","article-title":"The Lateral Hook Test: What is the Amount of Force that Should Be Applied to Evaluate Syndesmotic Instability Using Arthroscopy?","volume":"7","author":"Bhimani","year":"2022","journal-title":"Foot Ankle Orthop."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1136\/bjsports-2013-092787","article-title":"Diagnostic accuracy of clinical tests for ankle syndesmosis injury","volume":"49","author":"Sman","year":"2013","journal-title":"Br. J. Sport. Med."},{"key":"ref_51","unstructured":"Hocevar, L.A., and Fitzgerald, B.M. (2019). American Society of Anesthesiologists Staging. StatPearls, StatPearls Publishing LLC."},{"key":"ref_52","first-page":"98","article-title":"Experimental developement of the graphics rating method","volume":"18","author":"Hayes","year":"1921","journal-title":"Physiol. Bull."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1007\/BF00435553","article-title":"A scoring scale for symptom evaluation after ankle fracture","volume":"103","author":"Olerud","year":"1984","journal-title":"Arch. Orthop. Trauma Surg."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/0958-2592(91)90006-W","article-title":"Evaluation of ankle joint function: The use of a scoring scale","volume":"1","author":"Karlsson","year":"1991","journal-title":"Foot"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1001\/archsurg.1948.01240010266001","article-title":"Fractures of the ankle: Analytic Historic Survey as the Basis of New Experimental, Roentgenologic and Clinical Investigations","volume":"56","author":"Lauge","year":"1948","journal-title":"Arch. Surg."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1125","DOI":"10.1016\/j.injury.2011.01.009","article-title":"Increased rates of wound complications with locking plates in distal fibular fractures","volume":"42","author":"Schepers","year":"2011","journal-title":"Injury"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"181","DOI":"10.3109\/17453678008990784","article-title":"The Lauge Hansen Classification of Malleolar Fractures","volume":"51","author":"Yde","year":"1980","journal-title":"Acta Orthop. Scand."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1016\/S0020-1383(99)00110-2","article-title":"Early mobilisation versus immobilisation of surgically treated ankle fractures. Prospective randomised control trial","volume":"30","author":"Dogra","year":"1999","journal-title":"Injury"},{"key":"ref_59","unstructured":"Autoren, H., Belzl, U., Ernst, S., Heining, U., Hirsch, T., Riedel, J., Schmidt, M., and Settner, S. (2022, February 01). Deutsche Gesellschaft f\u00fcr Orthop\u00e4die und Unfallchirurgie (DGOU). Available online: https:\/\/dgou.de\/fileadmin\/dgou\/dgou\/Dokumente\/News\/News\/2020\/2020_Nachbehandlungsempfehlungen.pdf."},{"key":"ref_60","first-page":"354","article-title":"Documentation of self-reported patient outcomes in trauma surgery: Clinical benefits of patient reported outcome measures","volume":"123","author":"Greve","year":"2020","journal-title":"Unfallchirurg"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1911","DOI":"10.1007\/s00068-020-01337-w","article-title":"Nailing the fibula: Alternative or standard treatment for lateral malleolar fracture fixation? A broken paradigm","volume":"47","author":"Giordano","year":"2020","journal-title":"Eur. J. Trauma Emerg. Surg."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"3771","DOI":"10.1007\/s00402-021-04232-0","article-title":"Trends of incidence and treatment strategies for operatively treated distal fibula fractures from 2005 to 2019: A nationwide register analysis","volume":"142","author":"Milstrey","year":"2021","journal-title":"Arch. Orthop. Trauma. Surg."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"S255","DOI":"10.1016\/j.otsr.2014.03.005","article-title":"Internal fixation of the fibula in ankle fractures. A prospective, randomized and comparative study: Plating versus nailing","volume":"100","author":"Asloum","year":"2014","journal-title":"Orthop. Traumatol. Surg. Res."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13018-020-01622-9","article-title":"Treating AO\/OTA 44B lateral malleolar fracture in patients over 50 years of age: Periarticular locking plate versus non-locking plate","volume":"15","author":"Shih","year":"2020","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/j.clinbiomech.2016.05.006","article-title":"Reinforced fixation of distal fibula fractures in elderly patients; A meta-analysis of biomechanical studies","volume":"36","author":"Dingemans","year":"2016","journal-title":"Clin. Biomech."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/23\/7178\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:32:47Z","timestamp":1760146367000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/23\/7178"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,2]]},"references-count":65,"journal-issue":{"issue":"23","published-online":{"date-parts":[[2022,12]]}},"alternative-id":["jcm11237178"],"URL":"https:\/\/doi.org\/10.3390\/jcm11237178","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12,2]]}}}