EC Orthopaedics

Research Article Volume 17 Issue 1 - 2026

Dual Plating Technique: Outcome Comparisons in Complex Ankle Fractures and Concurrent Complex Comorbidities

J Joseph Anderson1*, Anthony M Chesser2, Devin S Bland3, Loren Spencer4, Devin Wahlen5, Adebola T Adeleke6, G Parker Peresko7, Riley Rampton8, Jacob M Jones9, Geoffrey Cady10 and Brooke Lynn Anderson11

1Surgeon and Partner at New Mexico Bone and Joint Institute Alamogordo, New Mexico, Fellowship Director at American Foundation of Lower Extremity Surgery and Research, USA

2Surgeon at Private Practice at ORA Orthopedics Moline, IL, USA

3Surgeon at Private Practice at Prestige Medical Care Phoenix, AZ, USA

4Surgeon and Partner at New Mexico Bone and Joint institute Alamogordo, NM, USA

5Surgeon at Private Practice at Eastern New Mexico Foot and Ankle Clovis, NM, USA

6Surgeon at Private Practice at Orthopedic Associates Middletown, CT, USA

7Surgeon at Arbor Health Hospital Morton, WA, USA

8Surgeon at Private Practice at Foot and Ankle Center Cache Valley, UT, USA

9Fellow at The American Foundation of Lower Extremity Surgery and Research, Alamogordo, NM, USA

10Surgeon at Private Practice at Gateway Foot and Ankle, Jefferson Hills, PA, USA

11Undergraduate at Northern Arizona University Flagstaff, AZ, USA

*Corresponding Author: J Joseph Anderson, Surgeon and Partner at New Mexico Bone and Joint Institute Alamogordo, New Mexico, Fellowship Director at American Foundation of Lower Extremity Surgery and Research, USA.
Received: November 24, 2025; Published: December 30, 2025




Ankle fractures are a common orthopedic injury which often require open reduction internal fixation (ORIF) in order to decrease the risk of posttraumatic arthritis. There are certain instances when more rigid fixation is needed i.e. osteopenia, neuropathy, and obesity. Dual/orthogonal plating of the fibula has been shown to be a promising adjunct in previous studies. The authors report on 181 dual plated fibulas and their postoperative outcomes vs standard single plating of the fibula. One thousand four hundred seventy-seven bimalleolar and trimalleolar ankle fractures were identified for this study. Retrospective chart review was performed for obesity, osteopenia, as well as neuropathy. Of the 1477 ankle fractures, 611 (41.37%) patients qualified for the study, 181 (29.62%) dual plate and 430 (70.38%) single plate constructs. In these records the areas that were compared were the following: dehiscence, failure of hardware fixation, loss of mortise length, height or width, loss of fibular length, catastrophic hardware failure, mal-unions, non-unions, and peroneal tendonitis. There were statistically significant P values when comparing single plate vs dual plating of the fibula in these areas: hardware failure (0.007), revisional surgery (0.007), hardware removal (0.034), Loss of fibula length (0.005), Loss of Mortise width (0.010), non-union/malunion (0.002), in the single plate group. Peroneal tendonitis, and postoperative cellulitis were not significant (0.10) and (0.94) respectively in either group. Single-plate fixation is significantly associated with increased post-operative complications in a population of patients with and without morbid obesity, osteoporosis, and/or neuropathy.

 Keywords: Anti-Glide; Morbidly Obese; Neuropathic; Orthogonal; Osteoporosis

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J Joseph Anderson., et al. “Dual Plating Technique: Outcome Comparisons in Complex Ankle Fractures and Concurrent Complex Comorbidities ”. EC Orthopaedics  17.1 (2026): 01-17.

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