Intramedullary nailing as an alternative to plate fixation in patients with distal fibular fracture

Kho, Duk-Whan; Kim, Hyeong-June; Kim, Byung-June; Choi, Seung-Myung

doi:10.1016/j.otsr.2019.10.009

Cited by 19 publications

(12 citation statements)

References 25 publications

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“…In the current study, the mean rates of postoperative complications in the IMN and ORIF groups were 9.5% and 39% ( P < .001), respectively, which was consistent with the results of multiple previous studies. 2-5,10-12,20,32,43 IMN surgery resulted in fewer wound complications, less nerve injuries, and less metalwork prominence than ORIF. However, considering that 4 patients in the IMN group underwent ankle arthrodesis due to PTOA compared to 2 patients in the ORIF group, this clinical result favoring the IMN should be interpreted with caution.…”

Section: Discussionmentioning

confidence: 92%

“…According to recent studies, the new-generation interlocking nailing device of the fibula we used has been reported to achieve satisfactory reduction comparable to the plate. 2,9-11,20,43 Moreover, in a recent meta-analysis, the mean rate of malunion after fibular IMN surgery was 3.6% (0%-6.7%) of the patients. 38 However, in our study, poor reduction at final follow-up was observed in 16.0% of patients treated with the fibular IMN as assessed using plain radiography and 20.3% as assessed using 3D-reconstructed CT, both of which are inferior to the results of previous studies.…”

Section: Discussionmentioning

confidence: 99%

“…After approval from our institutional review board, we performed a retrospective chart and radiographic review of 224 patients from a prospectively collected database and 61 patients in a randomized controlled trial 20 who had an unstable ankle fracture treated with CRIF using the fibular IMN or ORIF using the locking plate from January 2013 to December 2016. Patients were assigned to 2 groups without considering demographic characteristics, fracture type, or severity of the injury: those who underwent CRIF using the fibular IMN (IMN group) and those who underwent ORIF using the plate (ORIF group).…”

Section: Methodsmentioning

confidence: 99%

“…Fibular IMN surgery was performed with the Acumed fibular nail according to the operative technique described in a previous report. 20 After closed fracture reduction with distraction under fluoroscopic guidance, a 1-cm stab incision was made distal to the tip of the fibula. Then, a 1.6-mm guidewire was inserted under fluoroscopy to confirm an appropriate entry point of the ﬁbular nail, for ensuring that the guidewire was marginally 1 to 2 mm medial to the tip of the ﬁbula to avoid blowing the lateral wall and central at the tip of the fibula.…”

Section: Methodsmentioning

confidence: 99%

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Midterm Outcomes of Unstable Ankle Fractures in Young Patients Treated by Closed Reduction and Fixation With an Intramedullary Fibular Nail vs Open Reduction Internal Fixation Using a Lateral Locking Plate

2021

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Background: We aimed to compare midterm radiological and clinical outcomes between closed reduction and internal fixation (CRIF) using the fibular intramedullary nail (IMN) and open reduction and internal fixation (ORIF) using the locking plate for the treatment of unstable ankle fractures in active young patients. Methods: In this retrospective cohort study, 204 patients treated with CRIF using the fibular IMN (94 patients) or ORIF using the locking plate (110 patients) were included after at least 3 years of follow-up. The mean patient age was 41.4 years. Radiographic evaluation included the quality of reduction assessed by plain radiography and 3-dimensional (3D)–reconstructed computed tomography as well as the development of posttraumatic osteoarthritis (PTOA) of the ankle assessed by weightbearing plain radiography. Clinical evaluation included the American Orthopaedic Foot & Ankle Society hindfoot score, Olerud and Molander Score, the Foot and Ankle Outcome Score, and visual analog scale pain score as well as complications. Results: At median follow-up greater than 4 years, we found no significant differences in measured clinical outcomes between the 2 groups. There were signiﬁcantly fewer postoperative complications in the IMN group than in the ORIF group (9.5% vs 39%, P < .001). However, we did find a greater proportion of radiographically fair or poor reductions in the IMN group than in the ORIF group ( P < .001). The poor reductions in the IMN group were primarily related to Weber type C, pronation-type injury, and comminuted fibular and trimalleolar fractures ( P < .001). PTOA was also more frequently observed in the IMN group than in the ORIF group (21.3% vs 9.1%, P = .024). Conclusion: Given the current prevailing technologies for fracture fixation, this study suggests that surgeons should consider ORIF for unstable ankle fractures in active young patients with Weber type C, pronation-type injury, and comminuted fibular and trimalleolar fractures. Level of Evidence: Level III, retrospective comparative study.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Midterm Outcomes of Unstable Ankle Fractures in Young Patients Treated by Closed Reduction and Fixation With an Intramedullary Fibular Nail vs Open Reduction Internal Fixation Using a Lateral Locking Plate

2021

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“…6 Previous authors have reported no difference in functional outcome and a lower complication rate compared with plate fixation. [8][9][10] High-quality studies are, however, needed to allow conclusions to be drawn about the outcome of the fixation of unstable fractures of the ankle in elderly patients.…”

Section: Introductionmentioning

confidence: 99%

Higher complication rate after nail compared with plate fixation of ankle fractures in patients aged 60 years or older: a prospective, randomized controlled trial

Stake

Ræder

Gregersen

et al. 2023

The Bone & Joint Journal

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Aims The aim of this study was to compare the functional and radiological outcomes and the complication rate after nail and plate fixation of unstable fractures of the ankle in elderly patients. Methods In this multicentre study, 120 patients aged ≥ 60 years with an acute unstable AO/OTA type 44-B fracture of the ankle were randomized to fixation with either a nail or a plate and followed for 24 months after surgery. The primary outcome measure was the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score. Secondary outcome measures were the Manchester-Oxford Foot Questionnaire, the Olerud and Molander Ankle score, the EuroQol five-dimension questionnaire, a visual analogue score for pain, complications, the quality of reduction of the fracture, nonunion, and the development of osteoarthritis. Results At 24 months, the median AOFAS score was equivalent in the two groups (nail 90 (interquartile range (IQR) 82 to 100), plate 95 (IQR 87 to 100), p = 0.478). There were statistically more complications and secondary operations after nail than plate fixation (p = 0.024 and p = 0.028, respectively). There were no other significant differences in the outcomes between the two groups. Conclusion The functional outcome after nail and plate fixation was equivalent; however, the complication rate and number of secondary operations was significantly higher after nail fixation. These results suggest that plate fixation should usually be the treatment of choice for unstable ankle fractures in the elderly. Cite this article: Bone Joint J 2023;105-B(1):72–81.

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Efficacy of hook-type locking plate and partially threaded cancellous lag screw in the treatment of displaced medial malleolar fractures in elderly patients

Cho

Kim²,

Choi

2021

Arch Orthop Trauma Surg

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Intramedullary nailing as an alternative to plate fixation in patients with distal fibular fracture

Cited by 19 publications

References 25 publications

Midterm Outcomes of Unstable Ankle Fractures in Young Patients Treated by Closed Reduction and Fixation With an Intramedullary Fibular Nail vs Open Reduction Internal Fixation Using a Lateral Locking Plate

Midterm Outcomes of Unstable Ankle Fractures in Young Patients Treated by Closed Reduction and Fixation With an Intramedullary Fibular Nail vs Open Reduction Internal Fixation Using a Lateral Locking Plate

Higher complication rate after nail compared with plate fixation of ankle fractures in patients aged 60 years or older: a prospective, randomized controlled trial

Efficacy of hook-type locking plate and partially threaded cancellous lag screw in the treatment of displaced medial malleolar fractures in elderly patients

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