Fibula Nail Outcomes in Soft Tissue Compromised Ankle Fractures

Abstract

Background: To determine the clinical outcomes following fibula nail fixation and to identify the indication for the use of fibula nails in lower limb fractures. Methods: Retrospective study of adult patients from 2 major trauma centers (MTCs) and 9 trauma units (TUs) who underwent fibula nail fixation for AO/OTA 44 fractures between January 1, 2018, and October 31, 2020. Outcome measures included infection, metalwork complications, nonunion or malunion, time to union, and length of inpatient hospital stay. Results: Ninety-five patients were included, with a mean age of 66 years; 57.9% of patients were female. The average body mass index was 30. Sixty-nine patients (72.6%) sustained a Weber B and 24 (27.4%) sustained a Weber C fracture. In addition, 26.3% were open fractures and all patients had soft tissue compromise affecting the lateral malleolus. The calculated infection rate for fibula nail was 4.2% and metalwork complication rate was 5.2%. The nonunion and malunion rate was 8.4% and rate of removal of hardware was 2.1%. The average time to union was 12.5 weeks, and length of inpatient stay was 9.4 days (SD 10). Conclusion: This multicenter study demonstrates that use of a fibula nail appears to be a safe approach to treating patients who have a physiologically higher risk of surgery, poor skin condition, and a complex fracture pattern.

Intramedullary Fixation Versus Plate Fixation of Distal Fibular Fractures: A Systematic Review

“…Most of the articles that were included in the meta-analysis were of level 4 evidence; 4 of 29 studies (13.79%) were level 1 evidence, 16 , 21 - 23 2 of 29 studies (6.90%) were level 2, 12 , 24 6 of 29 studies (20.69%) were level 3 evidence, 25 26 27 28 29 30 and 17 of 29 studies (58.62%) were level 4 evidence 15 , 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 (Table 1 ). The outcomes of 1,850 patients after IMN and 514 patients after ORIF were available for analysis.…”

Complications following surgical treatment of ankle fractures in the elderly: can they be avoided?

“…26,27 To increase stability of the osteosynthesis, various treatment options are available, such as the combination of two non-locking plates 28 (posterior and lateral), the "K-Wire-Cage" technique 29 or the "Tibia-Pro-Fibula" concept. 30 In older patients with poor soft tissue conditions, it is recommended to consider less invasive techniques with small skin incisions, such as intramedullary fixation like retrograde percutaneous cannulated screw fixation 31 of malleolus as well as intramedullary implants like fibular nails 32 or Illuminoss. 33 Primary nail arthrodesis with a hindfoot nail can provide favorable outcomes in cases of severely compromised soft tissue and in patients with lower functional demands, allowing for early weight-bearing mobilization.…”

Foot & Ankle

“…This collaborative paper from Brighton (UK) set out to establish what the clinical outcomes of fibula nail fixation is, and when they are best used across two major trauma centres and nine trauma units in the UK. 6 Over a two-year period, the collaborative reported the outcomes of 95 patients treated with a fibula nail. A quarter were open fractures.…”