Optimizing Long-Term Outcomes and Avoiding Failure With the Fibula Intramedullary Nail

Carter, Thomas H.; Mackenzie, Samuel P.; Bell, Katrina R; Bugler, K.E.; MacDonald, Deborah J.; Duckworth, Andrew D.; White, Timothy O.

doi:10.1097/bot.0000000000001379

Cited by 17 publications

(22 citation statements)

References 16 publications

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“…Surprisingly, some of the SF-36 scales in our series trended even higher than in the normative patient population. The safety data recorded in this study are also in line with recent publications reporting relatively low complication rates associated with the use of a locked intramedullary fibular nail [20][21][22][23].…”

Section: Discussionsupporting

confidence: 89%

Safety and efficacy of surgical fixation of fibula fractures using an intramedullary nail: a retrospective observational cohort study in 30 patients

et al. 2019

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Background Open reduction and internal fixation remains the standard treatment for displaced unstable ankle fractures. Plate fixation represents the most frequently used instrumentation option in fibula fractures and favourable outcomes have been reported. Recently, intramedullary nailing techniques have been suggested as a viable alternative resulting in less soft tissue disruption. The objectives of this study are to describe the surgical technique and to evaluate the safety and efficacy of using an intramedullary nail in patients undergoing surgical fixation of their fibula fracture. Methods A total of 30 skeletally mature patients with unstable ankle fracture who underwent intramedullary fixation of their fibula fractures from February 2016 to July 2017 were included in this retrospective study. Patients were evaluated using the Short Form-36 (SF-36) and the American Orthopaedic Foot and Ankle Society (AOFAS) at 18 months after surgery. Results All patients went on to fracture union. Two patients required a secondary surgical procedure. No patient included in this series developed any wound complications. The mean Physical Component Summary (PCS) of the SF-36 was 53.90 ± 13.3 and the mean Mental Component Summary Score (MCS) was 52.63 ± 11.12. The AOFAS subscale scores were 34.67 ± 1.03 for pain, 42.40 ± 0.2997 for function and 9.50 ± 0.2785 for alignment. Conclusions Our study demonstrates promising outcomes associated with intramedullary nail fixation of unstable fibula fractures. We recommend intramedullary nail fixation of fibula fractures to be a safe procedure with a low complication rate. Level of evidence Level 4 retrospective case series.

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Section: Discussionsupporting

confidence: 89%

Safety and efficacy of surgical fixation of fibula fractures using an intramedullary nail: a retrospective observational cohort study in 30 patients

et al. 2019

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“…This finding may be attributed to closed reduction and limited axial instability in IMN surgery, which are consistent with those of previous studies suggesting that suboptimal fracture reduction of the fibula is one of the major factors for PTOA. 5,9-11,26 Particularly, in a logistic regression analysis, the presence of posterior malleolar fracture as well as Weber’s type C injury was found to be a risk factor developing PTOA in the IMN group. As mentioned above, posterior malleolar fracture has been reported as a major determinant of tibiotalar load transfer, posterior talar stability, and rotatory ankle stability.…”

Section: Discussionmentioning

confidence: 88%

“…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%

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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“…16,17 Considering the differences in injury severity and complication rates, the benefits of fibula IMN fixation of malleolar ankle fractures may be even more pronounced in pilon fractures. 9,10,14,15 Intramedullary fibula fixation of pilon fractures has only been investigated in a few small series. Stewart et al 9 reported on distally locked fibular IMN in 23 pilon fractures and demonstrated a 100% union rate, no wound complications, no revision surgeries, and one symptomatic fibula implant removal.…”

Section: Discussionmentioning

confidence: 99%

Complications after fibula intramedullary nail fixation of pilon versus ankle fractures

Faber

Parry

Haidukewych

et al. 2021

Journal of Clinical Orthopaedics and Trauma

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Background: Intramedullary nail (IMN) fixation of the fibula in malleolar ankle fractures has been shown to result in less wound complications then plate fixation. Therefore, IMN fibula fixation may also be associated with lower rates of wound complications when used for higher-risk pilon fractures. The purpose of this study was to compare complications of fibula IMN fixation in pilon versus malleolar ankle fractures. Methods: A retrospective cohort comparison was performed at an urban level one trauma center involving fibula fractures in 47 patients with AO/Orthopaedic Trauma Association (OTA) type 43 fractures and 48 patients with AO/OTA type 44 fractures being treated with fibula IMN fixation. Complications, fibula-specific complications, revision surgeries, and implant removals were reviewed. Results: There was no detectable difference in complications (27% vs. 23%, 95% confidence interval of the odds ratio (CIOR) 0.5 to 3.2), fibular-specific complications (6% vs. 10%, CIOR 0.1 to 3.5), revision surgeries (4% vs. 4%, CIOR 0.1 to 7.5), or symptomatic fibula implant removals (13% vs. 21%, CIOR 0.1 to 1.6) between pilon and ankle fracture groups, respectively. There was one (2%) fibular nonunion and one wound complication (2%) in each of the fracture groups. Conclusion: Fibula IMN fixation of pilon versus ankle fractures resulted in a similar number of complications. Comparative studies of fibula IMN and plate fixation are necessary to determine if the benefits of fibula IMN in ankle fractures extends to pilon fractures. Level of evidence: Level III, retrospective cohort.

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Optimizing Long-Term Outcomes and Avoiding Failure With the Fibula Intramedullary Nail

Cited by 17 publications

References 16 publications

Safety and efficacy of surgical fixation of fibula fractures using an intramedullary nail: a retrospective observational cohort study in 30 patients

Safety and efficacy of surgical fixation of fibula fractures using an intramedullary nail: a retrospective observational cohort study in 30 patients

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

Complications after fibula intramedullary nail fixation of pilon versus ankle fractures

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