|
1
|
Ochman S, Milstrey A, Raschke MJ. [Fractures of the upper ankle joint]. CHIRURGIE (HEIDELBERG, GERMANY) 2025; 96:254-268. [PMID: 39951055 DOI: 10.1007/s00104-024-02229-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/12/2024] [Indexed: 02/21/2025]
Abstract
Fractures of the upper ankle joint are frequent injuries and part of routine clinical trauma surgery. In recent years, treatment strategies have changed in different ways due to advances in imaging diagnostics and a better understanding of the biomechanics. In addition, new implant systems are available. The goals of the reconstruction are anatomical reduction with restoration of the joint anatomy, reconstruction of the length, rotation and axial relationships as well as the restoration of stable joint guidance. In addition to the bony reconstruction, the focus is on restoring ligamentous instabilities. Keywords that are increasingly more in focus and controversial are: the posterior malleolar fragment, syndesmosis instability, the fourth malleolus and the importance of the deltoid ligament. For a good long-term result, anatomical reconstruction remains the basic requirement, regardless of the methods used.
Collapse
Affiliation(s)
- S Ochman
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Albert Schweitzer Campus 1, Gebäude W1, 48149, Münster, Deutschland.
| | - A Milstrey
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Albert Schweitzer Campus 1, Gebäude W1, 48149, Münster, Deutschland
| | - M J Raschke
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Albert Schweitzer Campus 1, Gebäude W1, 48149, Münster, Deutschland
| |
Collapse
|
|
2
|
Rushing CJ. Comparison of Ankle Fracture Fixation Using Intramedullary Fibular Nailing Versus Plate Fixation. J Foot Ankle Surg 2024; 63:546-556. [PMID: 38825307 DOI: 10.1053/j.jfas.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 05/03/2024] [Accepted: 05/11/2024] [Indexed: 06/04/2024]
Abstract
Ankle fracture fixation using intramedullary fibular (IMF) nails has been shown to allow for earlier weightbearing, reduced wound complications, better union rates, and the absence of prominent hardware, compared to plates/screw (PS) constructs. The purpose of present retrospective cohort study was to compare outcomes of patients who underwent ankle fracture fixation using an IMF nail versus PS. Demographic, clinical, and radiographic data were recorded for patients who underwent ankle fracture fixation between May 2020 and May 2022, and who were at least 1 year postoperative. Toe-touch weightbearing was permitted immediately after surgery, protected weightbearing (PWB) at postoperative week 2, and weightbearing as tolerated in a brace at week 6. Radiographs were assessed preoperatively, and at 2, 6, 12, 24, and 48 weeks postoperative. Sixty-one ankle fractures (30 IMF, 31 PS) with a mean follow up of 14.7 and 18 (range, 12 to 23) months were included. Overall, the IMF nail cohort had less pain, faster time to union (11.4 vs 13.2 weeks), and less complications (23% vs 45%), reoperations (10% vs 16%), and surgical failures (9% vs 9.7%), compared to the PS cohort. The differences were not statistically significant. The PS cohort had a higher rate of symptomatic hardware irritation (p =< .001). Tobacco use adversely effected direct osseous healing (p < .001) and increased postoperative complications (p = .050). The present study lends credence to the previously reported advantages of IMF nailing over PS fixation for ankle fractures. Ankle fracture fixation using a fourth generation, IMF nail is a viable alternative to traditional PS fixation.
Collapse
|
|
3
|
Chaudhry YP, Gutierrez-Naranjo JM, Raad M, Ghanem D, Salazar LM, Goodrum JT, Luksameearunothai K, Zelle BA, Hasenboehler EA. Risk factors for malalignment after intramedullary nail treatment of distal tibia fractures with associated fibula fractures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:3265-3273. [PMID: 39136728 PMCID: PMC11377517 DOI: 10.1007/s00590-024-04062-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 07/31/2024] [Indexed: 09/07/2024]
Abstract
PURPOSE Malalignment of distal tibia fractures can lead to malunion/nonunion or alter the limb mechanical axis which may cause arthritis. Proposed methods to decrease malalignment include fibular fixation or multiplanar interlocking screws, however these remain controversial. This study aimed to identify factors associated with malalignment in distal tibial fractures with associated fibular shaft fractures. METHODS A retrospective review was performed of distal tibia fractures with associated fibular shaft fractures treated with intramedullary nailing at two level one trauma centers between 2015 and 2019. Cases involving malalignment (> 5° of deviation from anatomic axis on either coronal/sagittal axis) on final follow-up (minimum three months postoperatively) were compared to those without malalignment with regard to demographics, fracture characteristics, intraoperative characteristics, and complications. RESULTS The rate of malalignment was 13%. On multivariate analysis, multiplanar distal interlocking screw fixation (odds ratio [OR], 0.18; 95% confidence interval [CI] 0.03-0.92) was associated with a decreased rate of final malalignment, while nail diameter > 10 mm was associated with a higher rate (OR, 4.05; 95% CI 1.25-13.11). Fibular fixation was not associated with malalignment. CONCLUSION Multiplanar distal interlocking screws may protect against malalignment. Fibula fixation does not appear associated with a decreased rate of malalignment in distal tibia fractures treated with intramedullary nails. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Yash P Chaudhry
- Department of Orthopaedic Surgery, Philadelphia College of Osteopathic Medicine, 4190 City Avenue, Philadelphia, PA, 19131, USA.
| | | | - Micheal Raad
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Diane Ghanem
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Luis M Salazar
- Department of Orthopaedics, UT Health San Antonio, San Antonio, TX, USA
| | - Jason T Goodrum
- Department of Orthopaedics, UT Health San Antonio, San Antonio, TX, USA
| | | | - Boris A Zelle
- Department of Orthopaedics, UT Health San Antonio, San Antonio, TX, USA
| | - Erik A Hasenboehler
- Holy Spirit Medical Center Penn State Health, Orthopaedic Institute of Pennsylvania, Camp Hill, PA, USA
| |
Collapse
|
|
4
|
Zhang D, Litvak A, Lin N, Pirkle S, Strelzow J, Hynes K. Current Trends in the Surgical Treatment of Fibular Fractures: A National Database Study of Intramedullary vs. Plate Fixation Practice Patterns, Complications, and Cost. Adv Orthop 2024; 2024:7506557. [PMID: 39036541 PMCID: PMC11260212 DOI: 10.1155/2024/7506557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 05/14/2024] [Accepted: 06/24/2024] [Indexed: 07/23/2024] Open
Abstract
Existing primary evidence comparing fibular intramedullary fixation (IMF) with traditional plate fixation (PF) for the treatment of distal fibular fractures remains limited by modest sample sizes. Using a large national database, this study aims to compare use rates, fracture patterns, patient characteristics, time to surgery, complication rates, and cost between fibular IMF and PF within the United States. Adults treated with fibular IMF or PF between October 2015 and October 2021 were identified within the PearlDiver Database. The ratio of IMF-treated to PF-treated patients was tracked temporally to compare use rates. Fracture patterns were determined using fracture diagnoses within one-month preceding surgery. Further comparisons of IMF- and PF-treated groups only included patients with at least 12 months of follow-up, and patients with upper tibia or tibia shaft fractures were excluded. An analysis of cohorts matched at a 1 : 4 (IMF: PF) ratio to control for risk factors was performed to compare time to surgery, complication rates (infection, nonunion, malunion, revision, hardware removal, pulmonary embolism, and deep vein thrombosis), and cost. 39329 patients (2294 IMF and 37035 PF) were identified. IMF use trended upwards relative to PF use over time. Tibia and fibula shaft fractures were the most common injuries in IMF patients versus bimalleolar and trimalleolar fractures in PF patients. A higher proportion of IMF patients had open fractures. IMF patients were younger, with higher mean ECI, fewer female patients, and higher rates of CKD. Percutaneous approaches were more common among IMF patients. There were no significant differences in time to surgery or complication rates. IMF was less costly. The popularity of IMF trended upwards across the study period. IMF was used more commonly in injuries involving higher energy trauma and soft tissue disruption. Overall, IMF patients were younger with more comorbidities. When used in similar populations, IMF appears to be a cost-effective alternative to PF.
Collapse
Affiliation(s)
- Douglas Zhang
- The University of Chicago Pritzker School of Medicine, Chicago, IL 60637, USA
| | - Audrey Litvak
- The University of Chicago Pritzker School of Medicine, Chicago, IL 60637, USA
| | - Nicholas Lin
- The University of Chicago Pritzker School of Medicine, Chicago, IL 60637, USA
| | - Sean Pirkle
- Department of Orthopaedics and Sports MedicineUniversity of Washington, Seattle, WA 98195, USA
| | - Jason Strelzow
- Department of Orthopaedic Surgery and Rehabilitation MedicineUniversity of Chicago Medicine, Chicago, IL 60637, USA
| | - Kelly Hynes
- Department of Orthopaedic Surgery and Rehabilitation MedicineUniversity of Chicago Medicine, Chicago, IL 60637, USA
| |
Collapse
|
|
5
|
Le Baron M, Maman P, Volpi R, Flecher X. Full weight bearing after internal fixation of isolated distal fibular fractures with anatomically contoured locking plates: Our institutional experience. Injury 2024; 55 Suppl 1:111476. [PMID: 39069350 DOI: 10.1016/j.injury.2024.111476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 02/11/2024] [Accepted: 02/25/2024] [Indexed: 07/30/2024]
Abstract
Isolated fractures of the distal fibula mainly affect young, active people. In most cases, fixation is by open reduction with or without casting for six weeks without weight bearing. The current trend is to reduce this period of non-weight-bearing in order to promote earlier functional rehabilitation. The improved mechanical stability resulting from the use of plates with locking screws has changed the postoperative management of many fractures, but there is little evidence for the ankle. Between October 2013 and August 2015, 36 patients were enrolled in a prospective study to evaluate the performance of internal fixation of isolated distal fibular fractures using a lateral anatomically contoured titanium locking plate (InitialA® plate from Newclip Technics, Haute Goulaine, France) with immediate mobilisation and full weight bearing. No patient required further surgery due to mechanical failure or non-union. The bone healing rate was 100 % at 3 months. Two patients had septic complications requiring plate removal and antibiotic treatment and were eventually cured. The use of anatomically contoured locking plates provides strong and stable fixation, allowing immediate full weight-bearing. Such a technique has the advantage of a short recovery time and an early return to work without additional complications.
Collapse
Affiliation(s)
- Marie Le Baron
- Centre for Orthopaedic Surgery and Traumatology, North University Hospital, Marseille, Chemin des Bourrely, 13915 Marseille, France.
| | - Pascal Maman
- Centre for Orthopaedic Surgery and Traumatology, North University Hospital, Marseille, Chemin des Bourrely, 13915 Marseille, France
| | - Richard Volpi
- Centre for Orthopaedic Surgery and Traumatology, North University Hospital, Marseille, Chemin des Bourrely, 13915 Marseille, France
| | - Xavier Flecher
- Centre for Orthopaedic Surgery and Traumatology, North University Hospital, Marseille, Chemin des Bourrely, 13915 Marseille, France
| |
Collapse
|
|
6
|
Acevedo D, Rizzo MG, Constantinescu D, Heng M. The Use of Blocking Wires in Fibular Intramedullary Nailing of an Ankle Fracture with Hardware Failure: A Case Report. Cureus 2023; 15:e47737. [PMID: 38022253 PMCID: PMC10676240 DOI: 10.7759/cureus.47737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
A 24-year-old male, with a body mass index (BMI) of 31.7 and a previous open reduction and internal fixation (ORIF) of the left ankle seven years ago, presented to the emergency department with a peri-implant, comminuted fibula fracture with broken hardware and syndesmotic injury. The nature of the revision surgery made proper guidewire placement during fibular nailing difficult. Blocking wires assisted in ensuring proper guidewire placement. The patient was successfully managed with revision ORIF, fibular nailing, and syndesmotic fixation. Blocking wires are a helpful tool for achieving proper fracture alignment and stability during intramedullary nailing procedures and may be considered in fibular nailing situations.
Collapse
Affiliation(s)
- Daniel Acevedo
- Orthopaedic Surgery, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Davie, USA
| | - Michael G Rizzo
- Orthopaedic Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, USA
| | - David Constantinescu
- Orthopaedic Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, USA
| | - Marilyn Heng
- Orthopaedic Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, USA
| |
Collapse
|
|
7
|
Tansey PJ, Chen J, Panchbhavi VK. Current concepts in ankle fractures. J Clin Orthop Trauma 2023; 45:102260. [PMID: 37872976 PMCID: PMC10589378 DOI: 10.1016/j.jcot.2023.102260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/09/2023] [Indexed: 10/25/2023] Open
Abstract
Ankle fractures are among the most common orthopaedic injuries. Operative management is performed in unstable ankle fracture patterns to restore the stability and native kinematics of the ankle mortise and minimize the risk of post-traumatic degenerative changes. In this study, we review current concepts in ankle fracture management, including posterior malleolus fixation, syndesmosis fixation, deltoid ligament repair, fibular nailing, and early weightbearing, from both a biomechanical and clinical perspective.
Collapse
Affiliation(s)
- Patrick J. Tansey
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, 301 University Blvd, Route 0165, Galveston, TX, 77555-0165, USA
| | - Jie Chen
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, 301 University Blvd, Route 0165, Galveston, TX, 77555-0165, USA
| | - Vinod K. Panchbhavi
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, 301 University Blvd, Route 0165, Galveston, TX, 77555-0165, USA
| |
Collapse
|
|
8
|
Raschke MJ, Ochman S, Milstrey A. Ankle fractures in the elderly: Do we have new concepts? EFORT Open Rev 2023; 8:223-230. [PMID: 37158336 PMCID: PMC10233813 DOI: 10.1530/eor-23-0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
The relevance of geriatric ankle fractures is continuously increasing. Treatment of these patients remains challenging and requires adapted diagnostic and therapeutic strategies, as compliance to partial weight bearing is difficult to maintain compared to younger patients. In addition, in the elderly even low impact injuries may lead to severe soft tissue trauma, influencing timing and operative strategies. Recently, the direct posterolateral approach and plate fixation techniques, angular stable implants as well as intramedullary nailing of the distal fibula have been found to improve stategical concepts. This article aims to provide a comprehensive overview of the diagnostic and recent aspects with respect to how this difficult entity of injuries should be approached.
Collapse
Affiliation(s)
- Michael J Raschke
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany
| | - Sabine Ochman
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany
| | - Alexander Milstrey
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany
| |
Collapse
|
|
9
|
Giordano V, Azevedo PH, Peres C, Perucci M, Rodrigues M, Meireles R, Pires RE, Godoy-Santos A, Giannoudis PV. Can CT-based assessment of lateral malleolus anatomy indicate when and how to perform an intramedullary fixation in distal fibula fractures? An analysis of 150 ankles. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:601-609. [PMID: 35984518 DOI: 10.1007/s00590-022-03360-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/08/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE The primary aim was to analyse the lateral malleolus morphology with a focus on the shape of the distal fibula for IM fixation of the fibula in infra- and transsyndesmotic fracture patterns. The secondary aim was to propose a treatment algorithm according to the lateral malleolar anatomy. METHODS 77 healthy, skeletally mature volunteers underwent CT scanning of the ankle. The fibula medullary canal and its cortical thickness were quantitatively analysed at 4 different levels measured from the fibular tip (1.5 cm, 3.0 cm, 4.5 cm, and 6.0 cm). A geometric classification was proposed, and a decision algorithm was developed. Statistical significance was set at a p-value < 0.05. RESULTS The smallest diameter of the medullary canal of the fibula was at 6.0 cm from the tip of the fibula, in 98.2% of the ankles. The distal fibula can be classified into triangular and rectangular type, according to the cortical thickness index (p < 0.0001). In 16.7% ankles, the internal diameter of the fibula at 6.0 cm was equal or narrower than 3.5 mm (p < 0.05). CONCLUSION The shape of the distal fibula as evaluated by CT-guided analysis allows for IM osteosynthesis of the lateral malleolus in 83% of individuals. In our study, the smallest diameter of the medullary canal of the fibula was located 6.0 cm from the tip of the lateral malleolus. Coronal CT evaluation is advantageous in indicating which type of IM implant should be used safely for infra- and transsyndesmotic fracture patterns, potentially reducing intraoperative risks.
Collapse
Affiliation(s)
- Vincenzo Giordano
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rua Mário Ribeiro 117/2º andar, Leblon, Rio de Janeiro, RJ, 22430-160, Brazil.
- Clínica São Vicente, Rede D'or São Luiz, Rio de Janeiro, RJ, Brazil.
| | - Pedro Henrique Azevedo
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rua Mário Ribeiro 117/2º andar, Leblon, Rio de Janeiro, RJ, 22430-160, Brazil
| | - Caio Peres
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rua Mário Ribeiro 117/2º andar, Leblon, Rio de Janeiro, RJ, 22430-160, Brazil
| | - Marcelo Perucci
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rua Mário Ribeiro 117/2º andar, Leblon, Rio de Janeiro, RJ, 22430-160, Brazil
| | - Matheus Rodrigues
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rua Mário Ribeiro 117/2º andar, Leblon, Rio de Janeiro, RJ, 22430-160, Brazil
| | - Rafael Meireles
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rua Mário Ribeiro 117/2º andar, Leblon, Rio de Janeiro, RJ, 22430-160, Brazil
| | - Robinson Esteves Pires
- Departamento de Ortopedia, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Alexandre Godoy-Santos
- Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Peter V Giannoudis
- Academic Department of Trauma & Orthopaedic Surgery, School of Medicine, University of Leeds, Leeds, UK
| |
Collapse
|
|
10
|
Schumann J, Burgess B, Ryan D, Garras D. A Retrospective Analysis of Distal Fibula Fractures Treated With Intramedullary Fibular Nail Fixation. J Foot Ankle Surg 2023:S1067-2516(23)00068-6. [PMID: 36966965 DOI: 10.1053/j.jfas.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 12/15/2022] [Accepted: 03/18/2023] [Indexed: 04/26/2023]
Abstract
There is growing literature supporting the use of intramedullary fixation for fracture care because of its smaller incisions, improved biomechanical outcomes, and faster time to weightbearing than traditional internal fixation methods. The aim of this study is to investigate the postoperative outcomes in ankle fractures treated with intramedullary nail fixation in the largest patient cohort to date. From 2015 to 2021, 151 patients were evaluated following surgical treatment of fibular fractures with intramedullary nail fixation. Patients were identified through a medical record database search for appropriate ankle fracture procedure codes. Patient information was reviewed for fracture type, adjunct procedures, time to weightbearing and postoperative complications. Radiographs were assessed for quality and time to radiographic union. The mean time to weightbearing was 4.8 weeks. Minor wound dehiscence was identified in 2 patients (1.3%). Superficial infection was present in 4 patients (2.6%) and a deep infection developed in 2 patients (1.3%). Two patients developed a nonunion (1.5%). There were no DVTs reported, although 1 patient developed a PE postoperatively. Radiographic quality of reduction and time to union is comparable to literature reported plate and screw construct outcomes. Reduction was classified as good in 86.1% of patients and radiographic union was appreciated in 98.5% of patients. This is the largest cohort study evaluating the outcomes of intramedullary nail fixation for ORIF of ankle fractures. These data reinforce that intramedullary nailing provides a minimally invasive approach with accurate anatomic reduction, excellent fracture union rates, low complication rates, and an early return to weightbearing.
Collapse
Affiliation(s)
- Jaclyn Schumann
- Foot and Ankle Fellow, Hinsdale Orthopaedics a Division of Illinois Bone & Joint Institute, Joliet, IL.
| | - Brian Burgess
- Director of Hinsdale Orthopaedics (IBJI) Foot and Ankle Fellowship, Hinsdale Orthopaedics a Division of Illinois Bone & Joint Institute, Joliet, IL
| | - Daniel Ryan
- Podiatric Medicine and Surgery Residency Program PGY-2, Advocate Christ Medical Center, Oak Lawn, IL
| | - David Garras
- Foot and Ankle Orthopedic Surgeon, Midwest Orthopedic Consultants, Oak Lawn, IL
| |
Collapse
|
|
11
|
Fibula Nail versus Locking Plate Fixation-A Biomechanical Study. J Clin Med 2023; 12:jcm12020698. [PMID: 36675627 PMCID: PMC9862725 DOI: 10.3390/jcm12020698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/10/2023] [Accepted: 01/12/2023] [Indexed: 01/18/2023] Open
Abstract
In the treatment of ankle fractures, complications such as wound healing problems following open reduction and internal fixation are a major problem. An innovative alternative to this procedure offers a more minimally invasive nail stabilization. The purpose of this biomechanical study was to clarify whether this method was biomechanically comparable to the established method. First, the stability (range of motion, diastasis) and rotational stiffness of the native upper ankle were evaluated in eight pairs of native geriatric specimens. Subsequently, an unstable ankle fracture was created and fixed with a locking plate or a nail in a pairwise manner. The ankles showed significantly less stability and rotational stiffness properties after nail and plate fixations than the corresponding native ankles (p < 0.001 for all parameters). When comparing the two methods, both showed no differences in their range of motion (p = 0.694) and diastasis (p = 0.166). The nail also presented significantly greater rotational stiffness compared to the plate (p = 0.001). However, both fixations remained behind the native stability and rotational stiffness. Due to the comparable biomechanical properties of the nail and plate fixations, an early weight-bearing following nail fixation should be assessed on a case-by-case basis considering the severity of fractures.
Collapse
|
|
12
|
Guo W, Wu F, Chen W, Tian K, Zhuang R, Pan Y. Can Locked Fibula Nail Replace Plate Fixation for Treatment of Acute Ankle Fracture? A Systematic Review and Meta-Analysis. J Foot Ankle Surg 2022; 62:178-185. [PMID: 36333182 DOI: 10.1053/j.jfas.2022.10.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 09/13/2022] [Accepted: 10/01/2022] [Indexed: 11/07/2022]
Abstract
The standard surgical treatment for unstable ankle fractures involves open reduction and internal fixation (ORIF) with plates. However, ORIF has been associated with several complications, such as soft tissue irritation, wound infection, and nerve injury. Previous studies have shown that closed reduction and internal fixation with locked intramedullary nails (LIMNs) yields satisfactory efficacy in the treatment of ankle fractures and is associated with low complication rates. Therefore, a systematic review and meta-analysis of randomized controlled trials is imperative to provide evidence on whether or not LIMN fixation is comparable to or superior than traditional ORIF. We conducted a comprehensive literature search in the PubMed, Cochrane Library and EMBASE databases. A total of 4 randomized controlled trials involving 359 participants who suffered ankle fractures were included in this systematic review and meta-analysis. The results showed that the LIMN fixation group was statistically significant in terms of functional outcomes at the 3-month follow-up and wound-related complications. There was no statistical advantage for patients in the LIMN fixation group in terms of nonwound-related complications, total complications, or mid-term follow-up functional outcomes. There was no statistical difference between the LIMN and ORIF groups regarding operation time and quality of reduction. We believe LIMN fixation is a viable option for the treatment of unstable ankle fractures in both young and elderly individuals.
Collapse
Affiliation(s)
- Wenxuan Guo
- Department of Orthopaedics, The First Affiliated Hospital of Zhejiang Chinese Medical University, The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Fan Wu
- Department of Orthopaedics, The First Affiliated Hospital of Zhejiang Chinese Medical University, The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Wenhuan Chen
- Third Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Kun Tian
- Department of Orthopaedics, The First Affiliated Hospital of Zhejiang Chinese Medical University, The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Rujie Zhuang
- Department of Orthopaedics, The First Affiliated Hospital of Zhejiang Chinese Medical University, The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yu Pan
- Department of Orthopaedics, The First Affiliated Hospital of Zhejiang Chinese Medical University, The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
| |
Collapse
|
|
13
|
Bastías GF, Bravo F, Astudillo C, Giannini E, Contreras M, Melo R, Muñoz G, Pellegrini MJ, Cuchacovich N. Restoration of Anatomic Parameters and Syndesmotic Reduction After Intramedullary Nailing of Distal Fibular Fractures. FOOT & ANKLE ORTHOPAEDICS 2022; 7:24730114221141388. [PMCID: PMC9742579 DOI: 10.1177/24730114221141388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: Intramedullary nailing of the fibula (FN) is a method of fixation that has proven to be useful for treating distal fibular fractures (DFs). FN minimizes soft tissue complications and provides similar stability to plating, with fewer hardware-related symptoms. Nevertheless, FN has been associated with syndesmotic malreduction and the incapacity of restoring length and rotation of the fibula. We aimed to evaluate the fibular position and syndesmotic reduction after fixation with FN compared with the uninjured ankle in the immediate postoperative period. Methods: Prospective cohort study. Patients with DF fractures treated with IN between January 2017 and January 2020 were included. Immediate postoperative bilateral ankle CT was obtained in all cases. Fibular rotation, length, and translation as well as syndesmotic diastasis were measured on both ankles and compared by 3 independent observers. Results: Twenty-eight patients were included (16 women). The mean age was 46 years (range 16-91). Fracture type distribution according to AO/ASIF classification included 19 patients with 44.B (67.9%), 8 patients with 44.C (28.6%), and 1 patient with a 44.A fracture (3.6%). No significant differences were identified considering fibular rotation (P = .661), syndesmotic diastasis (P = .147), and fibular length (P = .115) between the injured and uninjured ankle. Fibular translation had statistical differences (P = .01) compared with the uninjured ankle. The intraclass correlation coefficient showed an excellent concordance between observers except for fibular translation on the injured ankle. Conclusion: In this cohort, fixation of DF fractures with FN allows restoration of anatomical parameters of the ankle in terms of fibular rotation, length, and syndesmotic diastasis. However, fibular translation had significant differences compared with the uninjured ankle based on bilateral CT scan evaluation. Level of Evidence: Level II, prospective cohort study.
Collapse
Affiliation(s)
- Gonzalo F. Bastías
- Department of Orthopedic Surgery, Foot and Ankle Unit, Clínica Las Condes—Hospital del Trabajador, Universidad de Chile, Las Condes, Santiago, Chile
| | - Francisco Bravo
- Department of Orthopedic Surgery, Foot and Ankle Unit, Complejo Hospitalario San José—Mutual de Seguridad, Santiago, Chile
| | - Claudia Astudillo
- Department of Radiology, Clinica Las Condes, Las Condes, Santiago, Chile
| | - Esteban Giannini
- Department of Radiology, Hospital del Trabajador-Clinica MEDS, Santiago, Chile
| | - Martin Contreras
- Department of Orthopedic Surgery, Hospital del Trabajador, Santiago, Chile
| | - Rodrigo Melo
- Department of Orthopedic Surgery, Foot and Ankle Unit, Clinica Las Condes—Hospital Militar de Santiago, Santiago, Chile
| | - Gerardo Muñoz
- Department of Orthopedic Surgery, Foot and Ankle Unit, Clinica Las Condes, Las Condes, Santiago, Chile
| | - Manuel J. Pellegrini
- Department of Orthopedic Surgery, Foot and Ankle Service, Clinica Universidad de los Andes—Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Natalio Cuchacovich
- Department of Orthopedic Surgery, Foot and Ankle Unit, Clínica Las Condes—Hospital del Trabajador, Universidad de Chile, Las Condes, Santiago, Chile,Natalio Cuchacovich, MD, Department of Orthopedic Surgery, Foot and Ankle Unit, Clinica Las Condes—Hospital del Trabajador, Estoril 450, Las Condes, Santiago, 7591047, Chile.
| |
Collapse
|
|
14
|
A Prospective Randomized Study Comparing Functional Outcome in Distal Fibula Fractures between Conventional AO Semitubular Plating and Minimal Invasive Intramedullary "Photodynamic Bone Stabilisation". J Clin Med 2022; 11:jcm11237178. [PMID: 36498750 PMCID: PMC9736249 DOI: 10.3390/jcm11237178] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
(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® one-third semitubular plate (Group I) or a minimally invasive intramedullary photodynamic Bone StabilizationSystem (IlluminOss®) (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.
Collapse
|
|
15
|
Milstrey A, Baumbach SF, Pfleiderer A, Evers J, Boecker W, Raschke MJ, Polzer H, Ochman S. Trends of incidence and treatment strategies for operatively treated distal fibula fractures from 2005 to 2019: a nationwide register analysis. Arch Orthop Trauma Surg 2022; 142:3771-3777. [PMID: 34743217 PMCID: PMC9596585 DOI: 10.1007/s00402-021-04232-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 10/18/2021] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Valid epidemiological data about distal fibular fractures and their treatment strategies are missing. Innovative osteosynthesis techniques were introduced and improved during the past 15 years. The aim of this study was to investigate the epidemiologic development and the implementation of new treatment strategies in a nationwide register in Germany over a period of 15 years. MATERIALS AND METHODS Data of the German Federal Statistical Office from 2005 until 2019 were screened. Adults with a fracture of the distal fibula were included. Data were separated for gender, age and treatment strategy. RESULTS During the past 15 years, there was a steady annual incidence of distal fibula fractures of 74 ± 32 per 100,000 people without any significant changes (p = 0.436). 60.1% ± 0.6% of all fractures occurred in females. The annual incidence for male was nearly constant over the different age groups, whereas for female, there was a clear increase in incidence above the age of 40. Whereas 66% of fractures in between 20 and 30 years of age occurred in male, approximately 70% of fractures above the age of 60 occurred in females. The relative quantity of locking plates increased from 2% in 2005 to 34% in 2019. In 2019, only 1.02% of the patients were operated with an intramedullary nail. CONCLUSIONS Operatively treated distal fibular fractures revealed an age dependent increase in incidence in postmenopausal women compared to younger females. Regarding the treatment strategy, there was an increase in application of locking plates. The data implicate a typical fragility fracture related age and gender distribution for distal fibula fractures.
Collapse
Affiliation(s)
- Alexander Milstrey
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Muenster, WWU Muenster, Waldeyer Street 1, 48149, Muenster, Germany.
| | - Sebastian Felix Baumbach
- Department of Orthopaedics and Trauma Surgery, Musculosceletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - Alexander Pfleiderer
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Muenster, WWU Muenster, Waldeyer Street 1, 48149, Muenster, Germany
| | - Julia Evers
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Muenster, WWU Muenster, Waldeyer Street 1, 48149, Muenster, Germany
| | - Wolfgang Boecker
- Department of Orthopaedics and Trauma Surgery, Musculosceletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - Michael J Raschke
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Muenster, WWU Muenster, Waldeyer Street 1, 48149, Muenster, Germany
| | - Hans Polzer
- Department of Orthopaedics and Trauma Surgery, Musculosceletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - Sabine Ochman
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Muenster, WWU Muenster, Waldeyer Street 1, 48149, Muenster, Germany
| |
Collapse
|
|
16
|
Indications for retrograde intramedullary screw fixation of the distal fibula: a retrospective cohort series. OTA Int 2022; 5:e216. [PMID: 36569110 PMCID: PMC9782339 DOI: 10.1097/oi9.0000000000000216] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 06/18/2022] [Indexed: 12/27/2022]
Abstract
Introduction Ankle fractures are a common orthopaedic injury that often require surgical fixation. Because the comorbid population in the United States continues to survive longer, it has become routine to treat comorbid patients with unstable ankle fractures. The literature has identified comorbidities known to increase the risk of ankle fracture complications to include age 55 years or older, body mass index >29.9, polytrauma, open fractures, diabetes mellitus, smoking, peripheral neuropathy, and alcohol use. Methods We retrospectively reviewed 37 patients who received retrograde intramedullary screw fixation of the distal fibula, all of whom had preexisting conditions known to increase the rate of postoperative complications. Results Thirty-seven patients were included in this study, of whom 36 (97.3%) went on to union. Six of 37 patients (16.2%) had complications although only one (2.7%) was due to inadequate fixation. The average time to weight-bearing as tolerated was 57.2 days (15-115 days). Two patients (5.4%) had symptomatic instrumentation requiring removal after union. Two patients (5.4%) had delayed union of the distal fibula, which responded to the use of a bone stimulator. One patient (2.7%) developed a nonunion which led to chronic subluxation of the ankle joint. One patient (2.7%) had a minor medial ankle wound complication that was treated with oral antibiotics and local wound care. Conclusions Retrograde intramedullary screw fixation of the distal fibula is a viable alternative to plate and screw fixation in patients with unstable ankle fractures who have known risk factors for increased complications. However, not all distal fibula fractures are amenable to this fixation method. Level of Evidence Level III retrospective cohort study.
Collapse
|
|
17
|
Locked intramedullary nailing provides superior functional outcomes and lower complication rates than plate fixation of distal fibula fractures. A systematic review and meta-analysis of comparative studies. Foot Ankle Surg 2022; 28:986-994. [PMID: 35184992 DOI: 10.1016/j.fas.2022.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/25/2021] [Accepted: 02/09/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE This study aims to provide an updated systematic review and meta-analysis of comparative studies on the outcomes and complications of locked IMNs in comparison to ORIF using plates and screws, while avoiding limitations of similar published reviews. METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, two independent team members electronically searched MEDLINE (PubMed), EMBASE, Google Scholar, SCOPUS, and Cochrane databases throughout May 2021 using the following keywords with their synonyms: "Ankle fracture fixation" AND "Open reduction and internal fixation", "locked intramedullary nail", or "complications". The primary outcomes were (1) functional outcomes, (2) complications, and (3) reoperation, while the secondary outcomes were: (1) union rate, and (2) cost. INCLUSION CRITERIA comparative studies on outcomes and complications of plate open reduction and internal fixation (ORIF) vs. locked intramedullary nailing (IMN) of ankle fractures reporting at least one of the following parameters: functional outcomes, complications (infection, dehiscence, reoperation etc.), union, and cost. Studies reporting on non-locked intramedullary fibular nails were also excluded. RESULTS After the removal of duplicates, a total of 1461 studies were identified. After screening those records, 63 studies remained for full-text assessment. Out of those, four comparative studies with a total of 262 ankle fractures met the inclusion criteria for this meta-analysis. The mean 12 months postoperative Olerud and Molander Ankle Scores (OMAS) were reported by two studies, with a statistically significant difference in favor of IMNs (MD= 6.72, CI: 3.77-9.67, p<0.001, I2= 94%). In the ORIF group, the overall complication rate was 39/134 (29.1%) vs. 10/128 (7.8%) in the IMN group, with a statistically significant difference in favor of the IMN group (RR=3.23, CI:1.71-6.11, p<0.001, I2=34%). In the ORIF group, the overall infection rate was 11/134 (8.2%), while there were no infections in the IMN group, with a statistically significant difference in favor of the IMN group (RR=8.05, CI:1.51-42.82, p=0.01, I2=0%). In the ORIF group, the overall reoperation rate was 10/134 (7.5%) while the overall reoperation rate was 6/128 (4.7%) in the IMN group, with no statistically significant difference between groups (RR=1.49, CI: 0.60-3.70, p = 0.39, I2=0%). CONCLUSION Locked intramedullary nail fixation of distal fibula fractures could provide superior functional outcomes and lower complication rates in comparison to open reduction and plate fixation. Despite the high incidence of ankle fractures, the number of high-quality comparative studies remains limited in literature, especially on newer locked fibular nails, and large multicentric clinical trials are required before recommending locked IMNs as the new standard of care in distal fibula fractures.
Collapse
|
|
18
|
Walsh JP, Hsiao MS, LeCavalier D, McDermott R, Gupta S, Watson TS. Clinical outcomes in the surgical management of ankle fractures: A systematic review and meta-analysis of fibular intramedullary nail fixation vs. open reduction and internal fixation in randomized controlled trials. Foot Ankle Surg 2022; 28:836-844. [PMID: 35339374 DOI: 10.1016/j.fas.2022.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 01/30/2022] [Accepted: 03/15/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND What level I evidence exists to support the use of FNF for surgical management of ankle fractures in high risk patients? The purpose of this study was to compare clinical outcomes following fibular intramedullary nail fixation (FNF) and open reduction and internal fixation (ORIF) of ankle fractures. METHODS A systematic review of the current literature was performed according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Certainty of evidence reported according to GRADE (Grading of Recommendations Assessment, Development, and Evaluation). Our primary hypothesis was that patients undergoing FNF procedures to manage an ankle fracture would have significantly higher patient reported outcome scores (PROs) than patients undergoing ORIF. Primary study outcome measures were validated PROs. Secondary outcome measures included complication rate, secondary surgery rate, and bony union. RESULTS The primary outcome analysis revealed no evidence of a significant effect difference on Olerud and Molander Ankle Score (OMAS) PRO and no evidence of statistical heterogeneity. Secondary outcome analysis revealed a significant 0.30 (0.12-0.74 95CI) relative risk reduction for complications in FNF (P = 0.008). No evidence of an effect difference for bony union. The GRADE certainty of the evidence was rated as low for bone union. No evidence of reporting bias was appreciated. Sensitivity analyses did not significantly alter effect estimates. CONCLUSION This systematic review and meta-analysis restricted to evidence derived from RCTs revealed that the quality of evidence is reasonably strong and likely sufficient to conclude: (1) there is likely no clinically important difference between FNF and ORIF up to 12 months post-operatively, as defined by OMS (moderate certainty); (2) surgeons may reasonably expect reduced complications in 14 out of every 100 patients treated with FNF (moderate certainty); (3) there is likely no difference in bony union (low certainty). Future studies should investigate more patient-centered outcomes and if short-term findings are durable over time if these findings apply to lower risk populations. LEVEL OF EVIDENCE Systematic review and meta-analysis of level I evidence.
Collapse
Affiliation(s)
- John P Walsh
- Department of Orthopaedic Surgery, Valley Hospital Medical Center, Las Vegas, NV, USA; The Foot and Ankle Institute at Desert Orthopaedic Center, Las Vegas, NV, USA.
| | - Mark S Hsiao
- The Foot and Ankle Institute at Desert Orthopaedic Center, Las Vegas, NV, USA.
| | - Daniel LeCavalier
- Department of Orthopaedic Surgery, Valley Hospital Medical Center, Las Vegas, NV, USA.
| | - Ryland McDermott
- The Foot and Ankle Institute at Desert Orthopaedic Center, Las Vegas, NV, USA; Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV, USA.
| | - Shivali Gupta
- Department of Orthopaedic Surgery, Valley Hospital Medical Center, Las Vegas, NV, USA.
| | - Troy S Watson
- Department of Orthopaedic Surgery, Valley Hospital Medical Center, Las Vegas, NV, USA; The Foot and Ankle Institute at Desert Orthopaedic Center, Las Vegas, NV, USA.
| |
Collapse
|
|
19
|
Huang CW, Wu WT, Yu TC, Chen IH, Wang JH, Yeh KT. Retrograde Intramedullary Kirschner Wire Fixation as an Alternative for Treating Distal Fibular Shaft Fractures Combined with Distal Tibial Pilon Fractures. J Pers Med 2022; 12:jpm12071124. [PMID: 35887621 PMCID: PMC9315716 DOI: 10.3390/jpm12071124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/20/2022] [Accepted: 07/08/2022] [Indexed: 11/16/2022] Open
Abstract
Treatment or management techniques for pilon fractures are associated with high complication rates and poor outcomes. No consensus exists regarding the optimal surgical option for pilon fractures, especially for pilon fractures combined with distal fibular fractures. Accordingly, we explored the use of fibular fixation for treating pilon fractures involving distal fibular shaft fractures. We hypothesized that retrograde intramedullary Kirschner wire (K-wire) fixation is a suitable alternative technique for distal fibular fixation. We retrospectively reviewed the data of 156 patients who underwent surgery for pilon fractures at our hospital from May 2013 to May 2021. The radiographic and functional outcomes were comparable between the fibular intramedullary nailing (Group A; n = 80) and the fibular plating (Group B; n = 76) groups. Groups A and B differed significantly in total hospitalization time (11.4 vs. 18.2 days, p = 0.024), length of postoperative admission (6.8 vs. 11.4 days, p = 0.012), and total admission cost (USD 3624 vs. USD 6145, p = 0.004). We also noted that poor Olerud and Molander ankle scores were significantly associated with age (p = 0.008), smoking (p = 0.012), and preoperative admission length (p = 0.018). Retrograde intramedullary K-wire fixation produced a comparable 12-month functional outcome to plate fixation for distal fibular shaft fractures, rendering it a viable alternative method based on soft tissue condition.
Collapse
Affiliation(s)
- Cheng-Wei Huang
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan; (C.-W.H.); (W.-T.W.); (T.-C.Y.); (I.-H.C.)
| | - Wen-Tien Wu
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan; (C.-W.H.); (W.-T.W.); (T.-C.Y.); (I.-H.C.)
- School of Medicine, Tzu Chi University, Hualien 970374, Taiwan
| | - Tsai-Chiu Yu
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan; (C.-W.H.); (W.-T.W.); (T.-C.Y.); (I.-H.C.)
- School of Medicine, Tzu Chi University, Hualien 970374, Taiwan
| | - Ing-Ho Chen
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan; (C.-W.H.); (W.-T.W.); (T.-C.Y.); (I.-H.C.)
- School of Medicine, Tzu Chi University, Hualien 970374, Taiwan
| | - Jen-Hung Wang
- Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan;
| | - Kuang-Ting Yeh
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan; (C.-W.H.); (W.-T.W.); (T.-C.Y.); (I.-H.C.)
- School of Medicine, Tzu Chi University, Hualien 970374, Taiwan
- Correspondence: ; Tel.: +886-3-8561825-14713
| |
Collapse
|
|
20
|
Abstract
OBJECTIVES To evaluate the treatment of unstable lateral malleolar fractures using a fibula nail with both proximal and distal locking capabilities. DESIGN Retrospective review of 110 single-surgeon consecutive fibula nails. SETTING Single-surgeon, private practice community hospital. PATIENTS/PARTICIPANTS One hundred ten fractures, 92 OTA/AO 44B and 18 OTA/AO 44C. INTERVENTION FibuLock fibula nail (Arthrex, Naples, FL). MAIN OUTCOME MEASUREMENTS Demographic, operative, clinical, and radiographic outcome data. RESULTS One hundred two patients/102 fractures met criteria. Ninety percent had a f/u of ≥12 months (mean 12.2 months). All fractures healed. There were no superficial or deep infections, no nonunions, or malunions. Two fractures required conversion to plate fixation intraoperatively because of excessive comminution which precluded the use of a nail, while one patient sustained an iatrogenic superficial peroneal nerve neuroma. No patients reported implant irritation, and none have required implant removal. CONCLUSION Fibula nails with proximal locking capabilities offer an alternative to plating with the potential for lower complication rates and lower need for implant removal. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Collapse
|
|
21
|
A Prospective, Randomized, Controlled, Two-Center, International Trial Comparing the Fibular Nail With Open Reduction and Internal Fixation for Unstable Ankle Fractures in Younger Patients. J Orthop Trauma 2022; 36:36-42. [PMID: 33878069 DOI: 10.1097/bot.0000000000002140] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/02/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare the outcome of fibular nailing with plate fixation for unstable fractures of the ankle in a cohort of patients under the age of 65 years. SETTING 2 international university trauma centers. PATIENTS/PARTICIPANTS One hundred twenty-five patients who were 18-64 years of age with an acute unstable fracture of the ankle were included in the study. INTERVENTION Patients were randomized to fixation with a fibular nail (n = 63) or plate (n = 62) and were reviewed at 6 weeks, 3 months, 6 months, 1 year, and 2 years after surgery. MAIN OUTCOME MEASUREMENTS The primary outcome measure was the Olerud and Molander score at 1 year. Secondary outcomes were the rates of complications and reinterventions. RESULTS There was no difference between the 2 groups with respect to the primary outcome measure [mean Olerud and Molander score 78.4 in the nail group vs. 80.2 in the plate group (P = 0.621)]. Wound infections occurred in 2 patients who were treated with a nail and 9 patients who were treated with a plate, but this did not reach statistical significance. No difference was seen in the overall rate of complications and reinterventions between groups [28.6% in the nail group vs. 29% in the plate group (P = 0.955)]. CONCLUSIONS In younger patients with ankle fractures, no difference was found in the patient-reported outcome between fibular nail and plate fixation at 1 year after surgery. The fibular nail is an effective and safe option for the stabilization of ankle fractures in younger patients, although the benefits associated with reduced wound complications are not as apparent as for elderly patients. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Collapse
|
|
22
|
Kho DH, Cho BK, Choi SM. 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. Foot Ankle Int 2021; 42:1469-1481. [PMID: 34184908 DOI: 10.1177/10711007211017470] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
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.
Collapse
Affiliation(s)
- Duk-Hwan Kho
- Department of Orthopaedic Surgery, Konkuk University Chungju Hospital, Konkuk University School of Medicine, Chungju, Korea
| | - Byung-Ki Cho
- Department of Orthopaedic Surgery, School of Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Seung-Myung Choi
- Department of Orthopedic Surgery, Eulji University School of Medicine, Gyeonggi-do, Korea
| |
Collapse
|
|
23
|
Chen H, Li Z, Yang D, Wang P, Niu J, He X, Wu G. Clinical study of intramedullary nailing fixation for the treatment of Danis-Weber B in lateral malleolus fracture. J Int Med Res 2021; 49:3000605211047371. [PMID: 34713740 PMCID: PMC8645306 DOI: 10.1177/03000605211047371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To compare the clinical effects between anatomical locking plates and interlocking intramedullary nails in patients with Danis-Weber B lateral malleolus fractures. METHODS This retrospective study enrolled patients with Danis-Weber B fractures of the lateral malleolus. All the operations were completed by the same group of surgeons. The reduction effect, operation time, intraoperative blood loss, hospital stay, fracture healing time and ankle functional outcomes (Olerud-Molander Ankle Score [OMAS]) were compared. Postoperative complications, including incision infections, fixation discomfort and internal fixation loosening, were also compared. RESULTS This study enrolled 73 patients that were treated with either an anatomical locking plate (locking plate group; n = 37) or an interlocking intramedullary nail (intramedullary nail group; n = 36). There was no significant difference between the two groups in terms of reduction effect, hospital stay and OMAS. The intramedullary nail group had significantly lower operation time, intraoperative blood loss and fracture healing time compared with the locking plate group. Postoperative complications in the intramedullary nail group were significantly lower compared with the locking plate group. CONCLUSION Using intramedullary nails resulted in more satisfactory functional outcomes compared with using locking plates in patients with Danis-Weber B fractures of the lateral malleolus.
Collapse
Affiliation(s)
- Hongfeng Chen
- Department of Foot and Ankle Surgery, The Second Affiliated Hospital of Luohe Medical College, Luohe, Henan Province, China
| | - Zhen Li
- Department of Foot and Ankle Surgery, The Second Affiliated Hospital of Luohe Medical College, Luohe, Henan Province, China
| | - Dongsong Yang
- Department of Orthopaedics, The Second Affiliated Hospital of Luohe Medical College, Luohe, Henan Province, China
| | - Pengru Wang
- Department of Orthopaedics, The Second Affiliated Hospital of Luohe Medical College, Luohe, Henan Province, China
| | - Junke Niu
- Department of Orthopaedics, The Second Affiliated Hospital of Luohe Medical College, Luohe, Henan Province, China
| | - Xishun He
- Department of Orthopaedics, The Second Affiliated Hospital of Luohe Medical College, Luohe, Henan Province, China
| | - Guangliang Wu
- Department of Orthopaedics, The Second Affiliated Hospital of Luohe Medical College, Luohe, Henan Province, China
| |
Collapse
|
|
24
|
Pflüger P, Braun KF, Mair O, Kirchhoff C, Biberthaler P, Crönlein M. Current management of trimalleolar ankle fractures. EFORT Open Rev 2021; 6:692-703. [PMID: 34532077 PMCID: PMC8419795 DOI: 10.1302/2058-5241.6.200138] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
A trimalleolar ankle fracture is considered unstable and treatment is generally performed operatively. Computed tomography is important for the operative planning by providing an elaborated view of the posterior malleolus. Trimalleolar ankle fractures have a rising incidence in the last decade with up to 40 per 100,000 people per year. With a growing number of elderly patients, trimalleolar ankle injuries will become more relevant in the form of fragility fractures, posing a particular challenge for trauma surgeons. In patients with osteoporotic trimalleolar ankle fractures and relevant concomitant conditions, further evidence is awaited to specify indications for open reduction and internal fixation or primary transfixation of the ankle joint. In younger, more demanding patients, arthroscopic-assisted surgery might improve the outcome, but future research is required to identify patients who will benefit from assisted surgical care. This review considers current scientific findings regarding all three malleoli to understand the complexity of trimalleolar ankle injuries and provide the reader with an overview of treatment strategies and research, as well as future perspectives. Cite this article: EFORT Open Rev 2021;6:692-703. DOI: 10.1302/2058-5241.6.200138
Collapse
Affiliation(s)
- Patrick Pflüger
- Department of Trauma Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Karl-Friedrich Braun
- Department of Trauma Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Traumatology and Reconstructive Surgery including Department of Orthopedic Surgery, Charite Universitätsmedizin Berlin, Berlin, Germany
| | - Olivia Mair
- Department of Trauma Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Chlodwig Kirchhoff
- Department of Trauma Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Peter Biberthaler
- Department of Trauma Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Moritz Crönlein
- Department of Trauma Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| |
Collapse
|
|
25
|
Brewer P, Murray J, Barr L, Headon E, Davies H, Chadwick C, Blundell C, Davies M. Fibula nail fixation in ankle fractures with significant soft tissue compromise: a retrospective cohort study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:1257-1263. [PMID: 34420150 DOI: 10.1007/s00590-021-03088-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 07/29/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Intramedullary fixation of lateral malleolar fractures has increased in popularity recently with the introduction of the fibula nail. It has been proposed as an alternative fixation method in fractures to minimise soft tissue injury. The aim of this study was to evaluate the clinical and patient-reported outcomes of those who had an ankle fracture with concurrent significant soft tissue damage, treated with a fibula nail. METHODS Details of patients who were managed at our institution using a fibula nail were obtained from the trauma database. The Acumed Fibula Rod System (FRS) was used in all cases. Those who were less than 12 months following injury were excluded. Patients attended a follow-up clinic for measurement of range of movement, radiographs, and to complete MOX-FQ and EQ-5D questionnaires. RESULTS Twenty patients were identified. Eleven attended for review in person, and a further eight completed questionnaires (questionnaire response rate 95%). The mean age was 59 years (range 19-91). Twelve fractures were open, all of which were initially managed using an external fixator. One patient developed deep infection necessitating fusion. The mean MOX-FQ and EQ-5D scores were 53.6 and 0.649, respectively, at a median of 40 months post-injury. The mean EQ-VAS was 70. The range of movement of the affected side was significantly less than the unaffected side (p < 0.001 on paired t-test). CONCLUSION This study suggests that the FRS offers a reliable and acceptable alternative fixation technique for patients who have significant soft tissue injuries.
Collapse
Affiliation(s)
- Paul Brewer
- Orthopaedic Department, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, UK
| | - James Murray
- Orthopaedic Department, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, UK.
| | - Lynne Barr
- The Orthopaedic Department, East Suffolk and North Essex NHS Foundation Trust, Colchester, UK
| | - Elizabeth Headon
- Orthopaedic Department, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, UK
| | - Howard Davies
- Orthopaedic Department, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, UK
| | - Carolyn Chadwick
- Orthopaedic Department, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, UK
| | - Chris Blundell
- Orthopaedic Department, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, UK
| | - Mark Davies
- Orthopaedic Department, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, UK
| |
Collapse
|
|
26
|
Stake IK, Gregersen MG, Molund M, Östman B. Fibular Rod Osteosynthesis in Ankle Fractures With Compromised Soft Tissue. Foot Ankle Spec 2021; 16:121-128. [PMID: 34142578 DOI: 10.1177/19386400211018075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Complications after plate and screw fixation of ankle fractures are frequently reported in the literature, with a higher rate in patients with advanced age, comorbidities, and poor skin conditions. A reduced complication rate has been reported with intramedullary nailing (IMN) of the fibula; however, the indication has been based on the surgeon's preferences. We report the results after IMN in patients with compromised soft tissue exclusively. METHODS A total of 71 patients with 72 distal fibula fractures were included in this retrospective study. Information about medical history, the ankle injury, treatment, and complications were collected from the medical records. Additionally, the preinjury and 6-week follow-up radiographs were evaluated. RESULTS Postoperative information was available for a minimum of 4.3 years postoperatively or until death. In all, 10 patients had complications related to the nail and required secondary surgery. These included 6 symptomatic hardware issues, 2 construct failures, 1 deep infection, and 1 combined deep infection and construct failure. CONCLUSIONS After IMN of the fibula, 14% of the patients required reoperation. Our results support the previous literature suggesting IMN as an acceptable surgical alternative where the risk of complications with plate and screw fixation is considered too high. Compromised soft tissue is one important indication. LEVEL OF EVIDENCE Level IV: Case series without control.
Collapse
Affiliation(s)
| | | | - Marius Molund
- Department of Orthopaedic Surgery, Ostfold Hospital Trust, Graalum, Norway
| | - Bengt Östman
- Department of Orthopaedic Surgery, Ostfold Hospital Trust, Graalum, Norway
| |
Collapse
|
|
27
|
Canton G, Sborgia A, Maritan G, Fattori R, Roman F, Tomic M, Morandi MM, Murena L. Fibula fractures management. World J Orthop 2021; 12:254-269. [PMID: 34055584 PMCID: PMC8152440 DOI: 10.5312/wjo.v12.i5.254] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 02/01/2021] [Accepted: 04/05/2021] [Indexed: 02/06/2023] Open
Abstract
Isolated distal fibula fractures represent the majority of ankle fractures. These fractures are often the result of a low-energy trauma with external rotation and supination mechanism. Diagnosis is based on clinical signs and radiographic exam. Stress X-rays have a role in detecting associated mortise instability. Management depends on fracture type, displacement and associated ankle instability. For simple, minimally displaced fractures without ankle instability, conservative treatment leads to excellent results. Conservative treatment must also be considered in overaged unhealthy patients, even in unstable fractures. Surgical treatment is indicated when fracture or ankle instability are present, with several techniques described. Outcome is excellent in most cases. Complications regarding wound healing are frequent, especially with plate fixation, whereas other complications are uncommon.
Collapse
Affiliation(s)
- Gianluca Canton
- Department of Medical, Surgical and Life Sciences, Orthopaedics and Traumatology Unit, Trieste University, Trieste 34149, Italy
| | - Andrea Sborgia
- Department of Medical, Surgical and Life Sciences, Orthopaedics and Traumatology Unit, Trieste University, Trieste 34149, Italy
| | - Guido Maritan
- Department of Medical, Surgical and Life Sciences, Orthopaedics and Traumatology Unit, Trieste University, Trieste 34149, Italy
| | - Roberto Fattori
- Department of Medical, Surgical and Life Sciences, Orthopaedics and Traumatology Unit, Trieste University, Trieste 34149, Italy
| | - Federico Roman
- Department of Medical, Surgical and Life Sciences, Orthopaedics and Traumatology Unit, Trieste University, Trieste 34149, Italy
| | - Marko Tomic
- Department of Medical, Surgical and Life Sciences, Orthopaedics and Traumatology Unit, Trieste University, Trieste 34149, Italy
| | - Massimo Max Morandi
- Department of Orthopaedic Surgery, Louisiana State University Health Science Center, Shreveport, LA 71103, United States
| | - Luigi Murena
- Department of Medical, Surgical and Life Sciences, Orthopaedics and Traumatology Unit, Trieste University, Trieste 34149, Italy
| |
Collapse
|
|
28
|
Park YU, Kim SJ, Kim HN. Minimally invasive plate osteosynthesis using the oblong hole of a locking plate for comminuted distal fibular fractures. J Orthop Surg Res 2021; 16:281. [PMID: 33906661 PMCID: PMC8077965 DOI: 10.1186/s13018-021-02441-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/20/2021] [Indexed: 11/23/2022] Open
Abstract
Background Nonunion is a rare complication for distal fibular fractures. However, when there is a high degree of comminution, nonunion may occur. In this article, we describe a novel technique that uses the oblong hole of a locking plate to lengthen the fibula for fracture reduction. This technique is straightforward and allows for easy control of the comminuted fracture to restore length and rotation at the time of plate application without opening the fracture site. Methods Thirty-five consecutive patients, who were treated with the minimally invasive plate osteosynthesis (MIPO) technique for comminuted distal fibular fractures were retrospectively studied. The study included 19 men and 16 women, with a mean age of 47.0 years (range, 20 to 72). There were 3 lateral malleolar fractures with deltoid injury, 11 bimalleolar fractures, 7 trimalleolar fractures, and 14 distal tibiofibular fractures. The quality of fracture reduction was assessed by comparing the radiologic parameters (fibular length, talocrural angle, and medial clear space) between the affected ankle and the contralateral uninjured ankle. Results Two patients were not reachable and 5 declined to visit the clinic. For these 7 patients, the latest outcomes that were measured prospectively were used. Postoperative radiographs showed well-aligned ankle mortise, with fibular length restoration. The mean Olerud-Molander ankle score was 82.1 ± 10.7 at a mean of 27.2 months (range, 12 to 58). There was one case of nonunion and one case of superficial peroneal nerve injury. Conclusion The MIPO technique, using the oblong hole of a locking plate, achieved satisfactory restoration of length and rotation, bone union, and clinical outcomes for the comminuted distal fibular fractures.
Collapse
Affiliation(s)
- Young Uk Park
- Department of Orthopedic Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Gyeonggi-do, Republic of Korea
| | - Sung Jae Kim
- Department of Orthopedic Surgery, Dongtan Sacred Hospital, Hallym University, Hwaseong, South Korea
| | - Hyong Nyun Kim
- Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 948-1, Dalim-1dong, Youngdeungpo-gu, Seoul, 150-950, Republic of Korea.
| |
Collapse
|
|
29
|
Bäcker HC, Vosseller JT. Intramedullary fixation of fibula fractures: A systematic review. J Clin Orthop Trauma 2021; 18:136-143. [PMID: 33996458 PMCID: PMC8102757 DOI: 10.1016/j.jcot.2021.04.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 04/17/2021] [Accepted: 04/20/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Distal fibula fractures are common injuries that often require open reduction internal fixation. Intramedullary fixation of the fibula has been used historically, and interest has been renewed somewhat recently, although there is limited data assessing outcomes after intramedullary fibular fixation. The purpose of this study was to systematically evaluate the literature as it relates to the clinical and functional outcome after fibular fracture fixation using an intramedullary device. METHODS A literature review on Medline/Pubmed, EMBASE, Cochrane and Google was performed. In total, 1994 abstracts were reviewed of which 30 articles in English, German and French were included, all of which evaluated the clinical and functional outcome after fibular nail osteosynthesis. RESULTS Within the 30 studies, a total of 1116/1380 patients were treated with a fibular nail between 1986 and 2018. In total 11 different devices were investigated. Six articles compared fibular nail versus plate osteosynthesis and in five cases a prospective study was performed. The complication rate varied somewhat widely based on the implants used. The mean union rate was 99.1% with a mean follow-up of 19.0 months. In comparison to plate fixation the nail was superior in terms of complication rate in most studies. No unified assessment of functional outcome was used, and so comparison between studies was difficult. However, good and excellent results were obtained in 73%-100% of patients. CONCLUSION Current data on intramedullary fixation of the fibula is limited and suffers significantly from inconsistency in outcome reporting. It remains to be seen whether the potential advantages of intramedullary implants can both maintain the good results of other implants and improve on some aspects of more commonly used implants. LEVEL OF EVIDENCE III, systematic review.
Collapse
Affiliation(s)
- Henrik C. Bäcker
- Department of Orthopaedic Surgery, Columbia University Medical Center, NY, USA,Department of Orthopaedic Surgery, Charité Berlin, UniversityHospital, Berlin, Germany,Corresponding author. Department of Orthopaedic Surgery, Columbia University Medical Center/New York Presbyterian Hospital, 622 West 168th Street PH-11, New York, NY 10032, USA.
| | - J. Turner Vosseller
- Department of Orthopaedic Surgery, Columbia University Medical Center, NY, USA
| |
Collapse
|
|
30
|
Kyriacou H, Mostafa AMHAM, Davies BM, Khan WS. Principles and guidelines in the management of ankle fractures in adults. J Perioper Pract 2021; 31:427-434. [PMID: 33826430 PMCID: PMC8575982 DOI: 10.1177/1750458920969029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Ankle fractures are common injuries that have many physical and psychosocial complications. As a result, it is important to be aware of how these patients present and are managed perioperatively. Detailed guidelines from NICE and the British Orthopaedic Association have been produced on this topic, including recent developments such as the decision to weight-bear early after surgery and the use of virtual fracture clinics. This article provides an overview of the key perioperative factors that need to be considered in cases of ankle fracture and the relevant clinical guidelines.
Collapse
Affiliation(s)
- Harry Kyriacou
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | | | - Benjamin M Davies
- Department of Trauma & Orthopaedics, Addenbrooke's Hospital, Cambridge, UK
| | - Wasim S Khan
- Department of Trauma & Orthopaedics, Addenbrooke's Hospital, Cambridge, UK
| |
Collapse
|
|
31
|
Umbel BD, Sharpe BD, Reynolds C, Philbin TM. Intramedullary Fixation of Distal Fibula Fractures. Foot Ankle Spec 2021; 16:104-112. [PMID: 33682466 DOI: 10.1177/1938640021991735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Ankle fractures pose a unique challenge to the treating orthopedic surgeon. Intramedullary (IM) distal fibula fixation is a relatively newer entity offering a viable option to minimize wound complications while providing similar outcomes. Our study utilizes an IM nail featuring proximal fixation via IM talons ensuring maintenance of fracture reduction this is the largest case series utilizing this novel device assessing time to weight-bearing (WB) and fracture union in addition to the safety and reproducibility of percutaneous reduction. METHODS A retrospective case series was conducted on 51 ankle fractures treated with a single IM device for lateral malleolar fixation. Postoperative radiographs were assessed, qualifying reductions as good, fair, or poor based on a reduction classification. Patient charts were reviewed for fracture characteristics, reduction method, fracture union, time to WB, and complications. RESULTS Mean follow-up time was 32.2 weeks; 47 fracture reductions (92%) were classified as good, and 4 (8%) were fair. All but 1 fracture (98%) went onto union. Average time to union was 10.3 weeks. Average time to WB with and without a walking boot was 6.8 and 11.2 weeks, respectively. Two patients experienced painful hardware. One patient had a superficial wound infection. CONCLUSION When evaluating this novel IM device, fracture union and time to union were found to be acceptable, with minimal wound or other complications. Percutaneous reduction permitted good fracture reduction quality. Consistent time to WB for a variety of fractures was reliably demonstrated following operative fixation with this device, including those in the elderly population. LEVELS OF EVIDENCE Level IV: Clinical case series.
Collapse
|
|
32
|
Ochman S, Raschke MJ. [Ankle fractures in older patients : What should we do differently?]. Unfallchirurg 2021; 124:200-211. [PMID: 33566120 DOI: 10.1007/s00113-021-00953-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2021] [Indexed: 02/07/2023]
Abstract
As a result of the demographic developments ankle fractures in older patients are part of routine trauma surgery. Due to comorbidities, such as diabetes mellitus, reduced bone quality and limited compliance in follow-up treatment, these fractures are prone to complications. The primary goal in the treatment of older patients with ankle fractures is to maintain mobility. In contrast to young patients most fractures are unstable pronation-abduction injuries. In the diagnostics the recognition and optimization of factors influencing the outcome, such as the blood perfusion and the generous use of computed tomography (CT) are recommended. As in the case of younger patients, conservative treatment is reserved for stable fracture forms and, if there are contraindications, should also be initiated in the case of unstable injuries. The choice of approaches is different for surgical treatment, which is adapted to the soft tissues, if necessary minimally invasive and increasingly carried out by a posterolateral approach. The initial transfixation can reduce soft tissue problems. Special surgical techniques and implants that provide a high level of stability, such as dorsal plate positioning, hook plates, angular stable plate systems and intramedullary systems as well as additional options, such as tibia pro fibula constructs are used. Primary retrograde nail arthrodesis is reserved as a salvage procedure only for exceptional cases. As part of the follow-up treatment, an interdisciplinary approach with respect for and optimization of concomitant diseases seems to make sense.
Collapse
Affiliation(s)
- Sabine Ochman
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Albert Schweitzer Campus 1, Gebäude W1, Waldeyerstr. 1, 48149, Münster, Deutschland.
| | - Michael J Raschke
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Albert Schweitzer Campus 1, Gebäude W1, Waldeyerstr. 1, 48149, Münster, Deutschland
| |
Collapse
|
|
33
|
Xia D, Zhang Y, Ou T, Wang Y, Hao Z, Zhou P, Xu S. Combination of mini locking plate and nitinol arched shape-memory connector for purely lateral malleolus fractures: technique and clinical results. ANNALS OF TRANSLATIONAL MEDICINE 2021; 8:1573. [PMID: 33437772 PMCID: PMC7791235 DOI: 10.21037/atm-20-4055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Lateral malleolus fractures occur frequently. The common techniques for fixing purely lateral malleolus fractures are often challenging, owing to the extent of soft tissue damage and fracture non-union. Herein, we report a new treatment that entails minimally invasive insertion and continuous compression of the broken ends as a novel technique, and evaluate its clinical results. Methods This study enrolled 21 patients (13 males and 8 females; mean age 32.06±3.45 years, range 23–69 years) with purely lateral malleolus fractures. Each patient underwent open reduction treatment with a mini locking plate for internal fixation and compression of the fracture end with an Arched Shape-Memory Connector (ASC). The clinical assessments were made using the American Orthopedic Foot and Ankle Society (AOFAS) scores, which were recorded at the final follow-up visit. Results The patients were followed for an average of 14.7±1.2 months (range, 12–18 months). None of the patients showed surgical failure, and all of the purely lateral malleolus fractures healed in an average of 12.6±1.5 weeks (range, 10–16 weeks). The mean AOFAS score was 88.94 (range, 83–90). Conclusions The new treatment had beneficial outcomes for purely lateral malleolus fractures. Mini locking plates are minimally invasive for surgical intervention, and combined with continuous concentrated compression with an ASC to accelerate osseous healing, they aid in restoration of function and enable early rehabilitation with a low incidence of postoperative complications.
Collapse
Affiliation(s)
- Demeng Xia
- Department of Emergency, Changhai Hospital, Naval Medical University, Shanghai, China.,Department of Orthopaedics, The Naval Hospital of Eastern Theater Command of PLA, Zhoushan, China
| | - Yuntong Zhang
- Department of Emergency, Changhai Hospital, Naval Medical University, Shanghai, China.,Department of Orthopedics, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Tianle Ou
- Department of Clinical Medicine, The Naval Medical University, Shanghai, China
| | - Yang Wang
- Department of Emergency, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Zichen Hao
- Department of Emergency, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Panyu Zhou
- Department of Emergency, Changhai Hospital, Naval Medical University, Shanghai, China.,Department of Orthopedics, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Shuogui Xu
- Department of Emergency, Changhai Hospital, Naval Medical University, Shanghai, China.,Department of Orthopedics, Changhai Hospital, Naval Medical University, Shanghai, China
| |
Collapse
|
|
34
|
Luong K, Huchital MJ, Saleh AM, Subik M. Management of Distal Fibular Fractures With Minimally Invasive Technique: A Systematic Review. J Foot Ankle Surg 2021; 60:114-120. [PMID: 33172782 DOI: 10.1053/j.jfas.2020.05.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 05/30/2020] [Indexed: 02/03/2023]
Abstract
Ankle fractures are extremely common, with isolated distal fibular fractures being the most common variant. The current gold standard in treating unstable distal fibular fractures is open reduction internal fixation. However, with potential risk of wound complications, minimally invasive techniques have been introduced. This systematic review was performed to evaluate the clinical and functional outcomes of varying minimally invasive techniques including minimally invasive plate osteosynthesis, intramedullary (IM) nailing, and IM screw fixation. A comprehensive English literature search on PubMed was performed yielding 543 studies. With specific study selection criteria, a total of 13 articles were selected. After studying the reference of each of the 13 studies, an additional 7 articles were included, resulting in a total of 20 studies reviewed. A total of 8 articles reviewed used IM nailing as the fixation of choice with a total of 211 patients. Of the 211 patients, 33 experienced complications. Six articles using minimally invasive plate osteosynthesis were reviewed with a total of 264 patients. Of the 264 patients, 39 experienced complications. IM screw fixation was used in 6 articles reviewed with a total of 219 patients. There were 30 cases of complications from the 132 patients. Additionally, mean American Orthopedic Foot and Ankle Society hindfoot-ankle scores among all fixation types was 88.4 ± 3.40 whereas the mean Olerud and Molander Score among all fixation types was 76.7 ± 16.58. The results of this study indicate that minimally invasive techniques for fixation of distal fibular fractures can provide excellent functional results with low complication rates compared with traditional open reduction internal fixation.
Collapse
Affiliation(s)
- Kenny Luong
- Resident, Saint Mary's General Hospital, Department of Podiatry, Passaic, NJ
| | - Michael J Huchital
- Fellow, North Jersey Reconstructive Foot and Ankle Fellowship, Lyndhurst, NJ.
| | - Ali M Saleh
- Resident, Saint Mary's General Hospital, Department of Podiatry, Passaic, NJ
| | - Michael Subik
- Director, North Jersey Reconstructive Foot and Ankle Fellowship, Lyndhurst, NJ; Residency Director, Saint Mary's General Hospital, Department of Podiatry, Passaic, NJ
| |
Collapse
|
|
35
|
Yang JJ, Lee PY, Chen CM, Tseng HS. Outcomes of intramedullary steinmann pin fixation for concurrent fibula fracture in comminuted tibia shaft or distal metaphyseal tibia fractures. JOURNAL OF MEDICAL SCIENCES 2021. [DOI: 10.4103/jmedsci.jmedsci_200_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
|
36
|
Giordano V, Giannoudis PV, Boni G, Pires RE, Fukuyama JM, Godoy-Santos AL, Koch HA. Intramedullary nailing of lateral malleolus in ankle fractures - surgical technique and literature review. Rev Col Bras Cir 2020; 47:e20202508. [PMID: 32555970 DOI: 10.1590/0100-6991e-20202508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 03/29/2020] [Indexed: 11/22/2022] Open
Abstract
Our objective is to describe the technique of intramedullary (IM) nailing of lateral malleolus in the surgical management of ankle fractures. Fracture reduction is performed either percutaneously with a small pointed reduction clamp in simple oblique fractures or using longitudinal traction and rotation for comminuted fractures, thus reducing complications related to open reduction and internal fixation with a plate. The technique has been shown to be simple and reproducible. In addition, the technique allows early weight bearing, which accelerates rehabilitation and potentially fasten fracture healing. IM nailing is a viable option for the fixation of the of lateral malleolus in ankle fractures and should be considered in the surgeon's armamentarium.
Collapse
Affiliation(s)
- Vincenzo Giordano
- Hospital Municipal Miguel Couto, Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro - Rio de Janeiro - RJ - Brasil
| | - Peter V Giannoudis
- School of Medicine, University of Leeds, Academic Department of Trauma & Orthopaedic Surgery - Leeds - Leeds - Reino Unido
| | - Guilherme Boni
- UNIFESP - Escola Paulista de Medicina (EPM), Departmento de Ortopedia e Traumatologia - São Paulo - SP - Brasil
| | - Robinson Esteves Pires
- Universidade Federal de Minas Gerais (UFMG), Departamento de Ortopedia - Belo Horizonte - MG - Brasil
| | - Junji Miller Fukuyama
- Hospital Geral Vila Penteado, Serviço de Ortopedia e Traumatologia - São Paulo - SP - Brasil
| | - Alexandre Leme Godoy-Santos
- Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo (USP), Instituto de Ortopedia e Traumatologia (IOT) - São Paulo - SP - Brasil
| | - Hilton Augusto Koch
- Universidade Federal do Rio de Janeiro (UFRJ), Departamento de Radiologia - Rio de Janeiro - RJ - Brasil
| |
Collapse
|
|
37
|
Campos Becerra LH, Hernández Rodríguez MAL, Esquivel Solís H, Lesso Arroyo R, Torres Castro A. Bio-inspired biomaterial Mg-Zn-Ca: a review of the main mechanical and biological properties of Mg-based alloys. Biomed Phys Eng Express 2020; 6:042001. [PMID: 33444260 DOI: 10.1088/2057-1976/ab9426] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The toxicity of alloying elements in magnesium alloys used for biomedical purposes is an interesting and innovative subject, due to the great technological advances that would result from their application in medical devices (MDs) in traumatology. Recently promising results have been published regarding the rates of degradation and mechanical integrity that can support Mg alloys; this has led to an interest in understanding the toxicological features of these emerging biomaterials. The growing interest of different segments of the MD market has increased the determination of different research groups to clarify the behavior of alloying elements in vivo. This review covers the influence of the alloying elements on the body, the toxicity of the elements in Mg-Zn-Ca, as well as the mechanical properties, degradation, processes of obtaining the alloy, medical approaches and future perspectives on the use of the Mg in the manufacture of MDs for various medical applications.
Collapse
Affiliation(s)
- Luis Humberto Campos Becerra
- Facultad de Ingeniería Mecánica y Eléctrica., Biomateriales. Universidad Autónoma de Nuevo León (UANL), Pedro de Alba S/N, Ciudad Universitaria, San Nicolás de los Garza, México
| | | | | | | | | |
Collapse
|
|
38
|
Giordano V, Boni G, Godoy-Santos AL, Pires RE, Fukuyama JM, Koch HA, Giannoudis PV. Nailing the fibula: alternative or standard treatment for lateral malleolar fracture fixation? A broken paradigm. Eur J Trauma Emerg Surg 2020; 47:1911-1920. [PMID: 32144445 DOI: 10.1007/s00068-020-01337-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 02/25/2020] [Indexed: 01/14/2023]
Abstract
PURPOSE Despite the fact that open reduction and internal fixation with a plate, either non-locked or locked, is the standard of care for managing lateral malleolus fractures, intramedullary (IM) fixation of the fibula has been recently introduced as an alternative, mainly for some potential complicated situations. We hypothesized that almost all patterns of distal fibula fracture can be safely fixed with an IM device, with the potential benefit of providing biomechanical efficiency, but using a soft-tissue friendly implant. Here, we present a multicenter case series based on a proposed algorithm. PATIENTS AND METHODS Sixty-nine consecutive patients were managed with fibular IM fixation for closed malleolar fractures. Twenty patients were managed by IM screw fixation and 49 by fibular nailing. Outcome was measured both according to the American Orthopaedic Foot and Ankle Society (AOFAS) score for ankle and hindfoot, and the time to bone union. RESULTS The mean AOFAS for Group I was 99.35 ± 1.95 points and that for Group II was 89.30 ± 16.98 points. There were no significant differences between the fracture pattern, according to the Lauge-Hansen classification, and post-operative levels of pain and functional activity among patients in both groups (p > 0.05). All fractures healed uneventfully in both groups. The mean time to union for Group I was 8.15 weeks and for Group II was 8.25 weeks (p > 0.05). CONCLUSION In this multicenter case series, intramedullary fixation for the lateral malleolus fracture presented itself as a viable and safe option for the treatment of almost all patterns of fibula fracture in adults. Overall, we were able to demonstrate the potential indications of the proposed algorithm for the choice of IM implant for the lateral malleolus fracture in terms of the Lauge-Hansen staged classification.
Collapse
Affiliation(s)
- Vincenzo Giordano
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rua Mário Ribeiro 117/2º andar, Leblon, Rio de Janeiro, RJ, 22430-160, Brazil. .,Clínica São Vicente, Rede D'or São Luiz, Rio de Janeiro, RJ, Brazil.
| | - Guilherme Boni
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina (EPM), Sao Paulo, SP, Brazil
| | - Alexandre Leme Godoy-Santos
- Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo (USP), Sao Paulo, SP, Brazil.,Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil
| | - Robinson Esteves Pires
- Departamento de Ortopedia, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Junji Miller Fukuyama
- Serviço de Ortopedia e Traumatologia, Hospital Geral Vila Penteado, Sao Paulo, SP, Brazil
| | - Hilton A Koch
- Departamento de Radiologia, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Peter V Giannoudis
- Academic Department of Trauma and Orthopaedic Surgery, School of Medicine, University of Leeds, Leeds, UK
| |
Collapse
|
|
39
|
Emara KM, Diab RA, Essa MN, Gemeah M, Emara YK, Fleifil S. Percutaneous cannulated screw fixation in the treatment for diabetic ankle fractures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2020; 30:367-372. [PMID: 31555912 DOI: 10.1007/s00590-019-02558-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 09/16/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND Diabetic ankle fractures were usually treated by open reduction and internal fixation (ORIF) which may lead to Charcot joint, or conservative which may lead to pressure sores. For better results, minimally invasive procedures have been developed, which decrease complications and enable early mobilization and rapid rehabilitation. MATERIALS AND METHODS This is a retrospective study of a total of 26 uncontrolled diabetic patients: 8 males [30.8%] and 18 females [69.2%]. The mean age of the patients was 67.4 (range 60 to 75) years. We include only Weber A and B where 10 patients suffered from lateral malleolus only (38.5%), 11 patients with bi-malleolar ankle fracture (42.3%) and 5 patients with tri-malleolar fracture (19.2%). RESULTS The mean time to union was 6.92 weeks (range of 6 to 12 weeks). Weight-bearing has begun from the first day in 19 patients (73.1%), while 7 patients began weight-bearing 4 weeks after the operation (26.9%). Mean follow-up ranged from 2 to 5 years. Mean AOFAS was 96.12 (range of 60 to 99). Only 3 patients suffered from complication: One patient suffered from Charcot joint, one suffered from fracture displacement and needed revision, and one suffered from mal-reduction. Thus, the complication rate was 11.5%. CONCLUSION We believe that percutaneous cannulated screws technique is a simple and effective method that can be applied safely in uncontrolled DM patients with ankle fractures.
Collapse
Affiliation(s)
- Khaled M Emara
- Department of Orthopaedic Surgery, Ain Shams University Hospitals, Ramses St, Abbasiya Sq., Cairo, 11566, Egypt
| | - Ramy A Diab
- Department of Orthopaedic Surgery, Ain Shams University Hospitals, Ramses St, Abbasiya Sq., Cairo, 11566, Egypt.
| | | | - Mostafa Gemeah
- Faculty of Medicine, Al-Azhar University, Cairo, 11835, Egypt
| | - Yahya K Emara
- College of Engineering and Applied Science, University of Cincinnati, Cincinnati, 45219, USA
| | | |
Collapse
|
|
40
|
Gutschick JH, Lazicki RS. RETURNING A SPECIAL OPERATIONS CANDIDATE TO DUTY FOLLOWING AN AIRBORNE OPERATION INJURY: A CASE REPORT. Int J Sports Phys Ther 2020; 15:148-159. [PMID: 32089966 PMCID: PMC7015033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Musculoskeletal injuries are recognized as the leading health problem and primary source of injury, disability, and financial burden across the military.1-5 Special Operations Forces are at an increased risk of musculoskeletal injury due to increased physical demands, precipitous deployments, and continual training and deployment cycles.6,4 Multiple injury screening tools exist, yet decisions to return to duty are frequently deferred to individual institutional protocol or provider clinical decision making, with no accepted gold standard.2,3,4,5. PURPOSE The purpose of this case report is to describe the application of a system to return a Special Operations Forces candidate to duty following an ankle injury sustained during a military static line airborne operation while in the Special Forces Qualification Course. CASE DESCRIPTION The subject was a 34-year-old male with surgical fixation of a left distal fibular fracture with syndesmotic tear after landing from a static line airborne jump during the Special Forces Qualification Course. This case report provides a system to determine return to duty following an ankle fracture and provides a guide to returning a subject to participation, duty, and tactical performance training. OUTCOMES Outcome measures recorded were vast, as the use of multiple measures are more indicative of overall function than any single measure. Impairment based measures included Global Rating of Change Scale (GROC), Numeric Pain Rating Scale (NPRS), lateral step down and Closed Chain Dorsiflexion (CCDF). Functional outcome measures included: the Functional Movement Screen™ (FMS™), Lower Quarter Y-Balance (LQYB), three hop tests for distance, and physical performance metrics. DISCUSSION The most substantial challenge to this process was the lack of standardized and validated military return to duty testing and guidelines in the literature. Ideally, pre-injury assessment would provide a baseline; however, compared to peers, the subject was well within acceptable ranges for all physical performance metrics at final Return to Duty testing. The subject was returned to duty 10 months after initial injury being physically comparable to his cohorts and being able to complete all military requirements. LEVELS OF EVIDENCE 5.
Collapse
Affiliation(s)
| | - Randall Scott Lazicki
- Tactical Human Optimization, Rapid Rehabilitation and Reconditioning Program, US Army Special Operations Command, Fort Bragg, NC, USA
| |
Collapse
|
|
41
|
Sain A, Garg S, Sharma V, Meena UK, Bansal H. Osteoporotic Distal Fibula Fractures in the Elderly: How To Fix Them. Cureus 2020; 12:e6552. [PMID: 31942269 PMCID: PMC6942499 DOI: 10.7759/cureus.6552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Osteoporotic fractures of the distal fibula in elderly patients is a challenge to manage. Non-operative management has a poor outcome so operative management is preferred. There are a variety of options for operative management such as locked plate systems, anti-glide plate construct, dual plating constructs, fibula nail, plate with tibial pro-fibular screws, and injectable bone cement (polymethylmethacrylate (PMMA), calcium phosphate). However, no clear guidelines exist for the operative management of osteoporotic distal fibula fractures. The surgeon should detect osteoporotic fractures early to make the best use of resources and avoid complications such as implant failure.
Collapse
Affiliation(s)
- Arnab Sain
- Orthopaedics, All India Institute of Medical Sciences, New Delhi, IND
| | - Sitender Garg
- Orthopaedics, All India Institute of Medical Sciences, New Delhi, IND
| | - Vijay Sharma
- Orthopaedics, All India Institute of Medical Sciences, New Delhi, IND
| | - Umesh K Meena
- Orthopaedics, All India Institute of Medical Sciences, New Delhi, IND
| | - Hemant Bansal
- Orthopaedics, All India Institute of Medical Sciences, New Delhi, IND
| |
Collapse
|
|
42
|
Abstract
BACKGROUND Intramedullary implants have been used historically in long bone fractures with success. In recent years, a variety of intramedullary implants for the treatment of fibular fractures have been investigated. These various implants have not been assessed together in a cohesive manner. In this review, we assess implants used for intramedullary fixation of fibular fractures with respect to implant design and clinical results. METHODS A comprehensive systematic literature review for intramedullary implants in fibular fractures was performed. All publications that assessed intramedullary fibular implants were reviewed. In total, 11 different intramedullary nails were found. Clinical results obtained from these studies were reviewed. RESULTS The intramedullary implants used for fibular fracture fixation generally fell into one of 3 categories: an unlocked longitudinal strut, an implant roughly equivalent to a large screw, or a more traditionally locked intramedullary nail. Reported clinical results were generally good, although inconsistent outcome reporting greatly limited comparison between studies. Complication rates varied with the implants but were generally low. CONCLUSION Intramedullary implants for fibular fracture stabilization have changed over the years to improve stability. Although clinical results are limited, data suggest that these implants are safe and can potentially approximate more traditional implants. LEVEL OF EVIDENCE Level II, systematic review.
Collapse
Affiliation(s)
- Henrik C Bäcker
- Department of Orthopaedic Surgery, Columbia University Medical Center, NY, USA
| | - J Turner Vosseller
- Department of Orthopaedic Surgery, Columbia University Medical Center, NY, USA
| |
Collapse
|
|
43
|
Boni G, Sanchez GT, Arliani G, Zelle BA, Pires RE, Dos Reis FB. Safety and efficacy of surgical fixation of fibula fractures using an intramedullary nail: a retrospective observational cohort study in 30 patients. Patient Saf Surg 2019; 13:31. [PMID: 31636710 PMCID: PMC6792205 DOI: 10.1186/s13037-019-0211-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 09/24/2019] [Indexed: 11/10/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Guilherme Boni
- 1Department of Orthopaedics and Traumatology, Federal University of São Paulo, São Paulo, SP Brazil.,IFOR - Instituto de Fraturas, Ortopedia e Reabilitação, São Paulo, SP Brazil.,3HSC - Hospital São Camilo, São Paulo, SP Brazil
| | - Gustavo T Sanchez
- 1Department of Orthopaedics and Traumatology, Federal University of São Paulo, São Paulo, SP Brazil
| | - Gustavo Arliani
- 1Department of Orthopaedics and Traumatology, Federal University of São Paulo, São Paulo, SP Brazil
| | - Boris A Zelle
- 4Department of Orthopaedics, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, MC-7774, San Antonio, TX 78229 USA
| | - Robinson E Pires
- 5Department of the Locomotor Apparatus, Federal University of Minas Gerais, Belo Horizonte, MG Brazil
| | - Fernando B Dos Reis
- 1Department of Orthopaedics and Traumatology, Federal University of São Paulo, São Paulo, SP Brazil.,3HSC - Hospital São Camilo, São Paulo, SP Brazil
| |
Collapse
|
|
44
|
Tracey J, Vovos TJ, Arora D, Adams S, Parekh SG. The Use of Modern Intramedullary Nailing in Distal Fibula Fracture Fixation. Foot Ankle Spec 2019; 12:322-329. [PMID: 30269517 DOI: 10.1177/1938640018803734] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background. Lateral malleolus (LM) fixation is necessary for unstable ankle fractures. Traditional fixation relies on the use of plates through a lateral incision, wound healing can be an issue for such incisions. A novel intramedullary (IM) fixation device has been developed that can be placed through a minimal incision. The purpose of this study was to demonstrate the clinical efficacy of this device. Methods. A retrospective analysis was performed on patients who received IM fixation for isolated fibula, bimalleolar (BM), and trimalleolar (TM) fractures. Pertinent demographic information, operative factors, complications, and clinical outcomes were recorded. Results. Sixteen patients were included in the study with an average age of 59 years (range 35-86 years). Six patients presented with isolated LM fractures, four patients had a BM fracture with a syndesmotic injury, 2 patients sustained a LM fracture with an associated syndesmotic injury, 2 patients had a BM fracture, and 2 patients had a TM fracture with a syndesmotic injury. There was a 100% healing rate of the lateral malleolus without any cases of malunion or shortening. There were no cases of sural nerve or peroneal tendon injuries, nor any wound complications found. Conclusion. These findings demonstrate the safe and efficacious use of a novel intramedullary fixation device for fibula fractures with lower wound complications compared with published outcomes found with lateral fibular plating. The features of this device allow for reliable fixation of the fibula, maintaining length and minimizing wound issues. Levels of Evidence: Level IV: Case series.
Collapse
Affiliation(s)
- Joseph Tracey
- Medical University of South Carolina, Charleston, South Carolina (JT), University of Toronto at Scarborough, Toronto, Ontario, Canada (DA), and Orthopaedic Surgery, North Carolina Orthopaedic Clinic, Duke University Medical Center, Durham, North Carolina (TJV, SA, SGP)
| | - Tyler J Vovos
- Medical University of South Carolina, Charleston, South Carolina (JT), University of Toronto at Scarborough, Toronto, Ontario, Canada (DA), and Orthopaedic Surgery, North Carolina Orthopaedic Clinic, Duke University Medical Center, Durham, North Carolina (TJV, SA, SGP)
| | - Danny Arora
- Medical University of South Carolina, Charleston, South Carolina (JT), University of Toronto at Scarborough, Toronto, Ontario, Canada (DA), and Orthopaedic Surgery, North Carolina Orthopaedic Clinic, Duke University Medical Center, Durham, North Carolina (TJV, SA, SGP)
| | - Samuel Adams
- Medical University of South Carolina, Charleston, South Carolina (JT), University of Toronto at Scarborough, Toronto, Ontario, Canada (DA), and Orthopaedic Surgery, North Carolina Orthopaedic Clinic, Duke University Medical Center, Durham, North Carolina (TJV, SA, SGP)
| | - Selene G Parekh
- Medical University of South Carolina, Charleston, South Carolina (JT), University of Toronto at Scarborough, Toronto, Ontario, Canada (DA), and Orthopaedic Surgery, North Carolina Orthopaedic Clinic, Duke University Medical Center, Durham, North Carolina (TJV, SA, SGP)
| |
Collapse
|
|
45
|
Ebraheim NA, Vander Maten JW, Delaney JR, White E, Hanna M, Liu J. Cannulated Intramedullary Screw Fixation of Distal Fibular Fractures. Foot Ankle Spec 2019; 12:264-271. [PMID: 30091366 DOI: 10.1177/1938640018790082] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background: Open reduction and internal fixation (ORIF) methods, primarily plates and screws, remain the standard of treatment for distal fibular fractures. This study evaluates the use of a cannulated intramedullary screw as a minimally invasive treatment method for distal fibular fractures, which has not been reported in the current literature. Methods: This retrospective study included 45 patients with distal fibular fractures treated with cannulated intramedullary screw fixation. All patients included in the cohort had a soft-tissue condition and/or comorbidity. The mean age was 54 years. The Weber classification system was used to assess the type of fracture. Average time to union, average time to weight bearing, and complications were monitored. Results: Reduction quality criteria were collected using previously published guidelines. Accordingly, reduction was determined to be good in 25 cases, fair in 15, and poor in 5. A low complication rate of 4% was reported. Average time to union was 10 weeks (range = 8-36 weeks), whereas average time to weight bearing was 14 weeks (range = 8-40 weeks). Conclusion: Cannulated intramedullary screw fixation can serve as a minimally invasive, safe, and satisfactory treatment for distal fibular fractures with resulting high union rates and low complication rates. Levels of Evidence: Level IV: Retrospective, case series.
Collapse
Affiliation(s)
- Nabil A Ebraheim
- Department of Orthopaedic Surgery, University of Toledo Medical Center, Toledo, Ohio
| | | | - Joshua R Delaney
- Department of Orthopaedic Surgery, University of Toledo Medical Center, Toledo, Ohio
| | - Erik White
- Department of Orthopaedic Surgery, University of Toledo Medical Center, Toledo, Ohio
| | - Maged Hanna
- Department of Orthopaedic Surgery, University of Toledo Medical Center, Toledo, Ohio
| | - Jiayong Liu
- Department of Orthopaedic Surgery, University of Toledo Medical Center, Toledo, Ohio
| |
Collapse
|
|
46
|
Bazin I, Armendariz M, Marcheix PS, Pichon M, Fredon F, Mabit C, Mathieu PA. A computed tomography study of the fibula: morphology, morphometry, intramedullary anatomy, application prospects on intramedullary nailing. Surg Radiol Anat 2019; 41:681-687. [PMID: 30993418 DOI: 10.1007/s00276-019-02213-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 03/05/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE The intramedullary percutaneous pinning in fractures of the lateral malleolus is a technique of osteosynthesis that can reduce complications of ORIF. Our study describes the morphology and the morphometry of the fibula, in particular intramedullary, so as to specify the best fibular nail features. METHODS We conducted a retrospective study on CT acquisitions of fibulae in vivo. We studied total length, and the distal malleolar angle. Regarding intramedullary morphology, six axial study levels were defined. Each level was assigned a morphometric classification (oval, triangular, quadrangular or irregular), and a measure of the diameter of the cavity. The distance between the smaller diameter and the malleolar tip was investigated. RESULTS We included 50 patients for 97 fibulae. The average age was 66.5 years. The irregular morphology type was the most frequently found. The average length was 370.5 mm (SD = 18.1; CI 95% [366.9; 374.1]), the average distal malleolar angle was 163.5° (SD = 3.7; CI 95% [162.7; 164.2]). The average minimal intramedullary diameter at malleolus level was 3.2 mm (SD = 1.2; CI 95% [3.0; 3.5]), with a minimum size reaching 95.8 mm (SD = 13.8; CI 95% [93.0; 98.5]) of the malleolar tip. CONCLUSIONS The analysis of morphological parameters of the fibula, in particular the lateral malleolus and intramedullary morphology is necessary for the design of a morpho-adapted nail. Interpersonal variability must be taken into account by the implant industry to offer nails of suited lengths and diameters.
Collapse
Affiliation(s)
- I Bazin
- Centre Hospitalier Universitaire de Limoges Dupuytren, 2 Avenue Martin Luther King, 87000, Limoges, France.
| | - M Armendariz
- Centre Hospitalier Universitaire de Limoges Dupuytren, 2 Avenue Martin Luther King, 87000, Limoges, France
| | - P S Marcheix
- Centre Hospitalier Universitaire de Limoges Dupuytren, 2 Avenue Martin Luther King, 87000, Limoges, France
| | - M Pichon
- Centre Hospitalier Universitaire de Limoges Dupuytren, 2 Avenue Martin Luther King, 87000, Limoges, France
| | - F Fredon
- Centre Hospitalier Universitaire de Limoges Dupuytren, 2 Avenue Martin Luther King, 87000, Limoges, France
| | - C Mabit
- Centre Hospitalier Universitaire de Limoges Dupuytren, 2 Avenue Martin Luther King, 87000, Limoges, France
| | - P A Mathieu
- Centre Hospitalier Universitaire de Limoges Dupuytren, 2 Avenue Martin Luther King, 87000, Limoges, France
| |
Collapse
|
|
47
|
Dabash S, Eisenstein ED, Potter E, Kusnezov N, Thabet AM, Abdelgawad AA. Unstable Ankle Fracture Fixation Using Locked Fibular Intramedullary Nail in High-Risk Patients. J Foot Ankle Surg 2019; 58:357-362. [PMID: 30612876 DOI: 10.1053/j.jfas.2018.08.033] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Indexed: 02/03/2023]
Abstract
Open reduction internal fixation is the gold standard for unstable ankle fracture fixation; however, complications in patients with multiple medical comorbidities are common. Intramedullary nail fixation of the fibula can help to mitigate these difficulties. A retrospective chart review was performed on all patients who underwent fixation for unstable ankle fracture between January 2015 and March 2016 at our level I trauma center. Comorbidities in the patient sample included were one or several of diabetes, renal disease, hypertension, advanced age with osteoporosis, hemorrhagic blisters, and alcoholism. The primary outcomes studied were wound complications, infections, and hardware failure or failure of fixation. Eighteen patients with a mean age of 61 years underwent fibular intramedullary nail fixation, all of whom were considered at high risk for postoperative complications. Patients presented with Weber B or C fracture patterns. All patients had syndesmotic fixation through the nail by one or two 3.5-mm tricortical screws. A medial malleolus was added if needed for stability. The average follow-up time was 291.1 (range 9 to 14 months) days. The prescribed range of time to weightbearing was 2 to 6 weeks. All patients maintained reduction of the fracture and had no wound complications. No syndesmotic screws broke postoperatively, although most patients to failed comply with the postoperative non-weightbearing restrictions. Intramedullary nailing of the fibula with syndesmotic intranail fixation is minimally invasive, quick, and provides adequate fixation strength. It offers a viable treatment option for patients at high risk for complications or who are suspected to have difficulty with follow-up or compliance.
Collapse
Affiliation(s)
- Sherif Dabash
- Foot and Ankle Clinical Fellow, Department of Orthopaedic Surgery, University of Texas Health Science Center at Houston, Houston, TX
| | | | - Eric Potter
- Medical Student, Texas Tech University Health Science Center/Paul L. Foster School of Medicine, El Paso, TX
| | - Nicholas Kusnezov
- Orthopaedic Surgery Resident, William Beaumont Army Medical Center, El Paso, TX
| | - Ahmed M Thabet
- Associate Professor of Orthopaedic Surgery, Texas Tech University Health Science Center/Paul L. Foster School of Medicine, El Paso, TX
| | - Amr A Abdelgawad
- Chairman of Orthopedic Department, Texas Tech University Health Science Center/Paul L. Foster School of Medicine, El Paso, TX.
| |
Collapse
|
|
48
|
Smeeing DPJ, Briet JP, van Kessel CS, Segers MM, Verleisdonk EJ, Leenen LPH, Houwert RM, Hietbrink F. Factors Associated With Wound- and Implant-Related Complications After Surgical Treatment of Ankle Fractures. J Foot Ankle Surg 2019; 57:942-947. [PMID: 30005967 DOI: 10.1053/j.jfas.2018.03.050] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Indexed: 02/03/2023]
Abstract
We have described the epidemiology of complications after surgical treatment of ankle fractures and assessed which factors are associated with the most frequent complications. We conducted a retrospective cohort study at 2 level 2 and 1 level 1 trauma center in a single trauma region in the Netherlands. The study variables were collected from the electronic medical patient records; all ankle fractures were classified using the Lauge-Hansen classification, and the complications were recorded. A total of 989 patients were included from 3 hospitals, with 173 complications in 156 patients (15.8%). The most frequent complication was wound related, occurring in 101 patients (10.2%). Implant-related complications occurred in 44 patients (4.4%). Other complications, such as cast pressure spots, posttraumatic dystrophy, nonunion, impingement, and pneumonia occurred in 28 patients (2.8%). The 2 most important complications were further analyzed for risk factors. Multivariate analysis showed the risk factors for wound-related complications were advanced age, increased American Society of Anesthesiologists classification, smoking, right side symptomatic, open fracture, and initial external fixation. Most implant-related complications were caused by malreduction (n = 22) or untreated syndesmotic injury (n = 19). Malreduction was associated with supination eversion fractures (p = .059), and untreated syndesmotic injury occurred more often with pronation external rotation fractures (p < .001). The most frequent complications after ankle fracture surgery were wound- and implant-related complications. Postoperative wound-related complications were multifactorial and dependent on a combination of trauma-, patient-, and treatment-related factors. In contrast, implant-related complications resulted from the interaction between the fracture type and subsequent surgical treatment.
Collapse
Affiliation(s)
- Diederik P J Smeeing
- Surgical Resident, Traumacenter Utrecht, Utrecht, The Netherlands; Surgical Resident, Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Jan P Briet
- Surgical Resident, Department of Surgery, Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | - Charlotte S van Kessel
- Surgical Resident, Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Michiel M Segers
- Trauma Surgeon, Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Egbert J Verleisdonk
- Trauma Surgeon, Department of Surgery, Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | - Luke P H Leenen
- Professor in Trauma Surgery, Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Roderick M Houwert
- Trauma Surgeon, Traumacenter Utrecht, Utrecht, The Netherlands; Trauma Surgeon, Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Falco Hietbrink
- Trauma Surgeon, Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
|
49
|
Falzarano G, Pica G, Medici A, Rollo G, Bisaccia M, Cioffi R, Pavone M, Meccariello L. Foot Loading and Gait Analysis Evaluation of Nonarticular Tibial Pilon Fracture: A Comparison of Three Surgical Techniques. J Foot Ankle Surg 2019; 57:894-898. [PMID: 29914730 DOI: 10.1053/j.jfas.2018.03.025] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Indexed: 02/03/2023]
Abstract
The aim of our study was to investigate which technique among hybrid external fixation, plate and screws, and intramedullary nailing produces better outcomes in foot loading when treating type 43.A1, 43.A2, and 43.A3 fractures, according to the AO classification. From November 2011 to December 2014, 34 patients, including 25 (73.5%) males and 9 (26.5%) females with an average age of 32.3 (range 16 to 67) years, with a type A tibia fracture were treated with intramedullary nailing, plate and screws, or hybrid external fixation. The patients were divided into 3 groups: 16 (47%) received hybrid external fixation, 10 (29.4%) received plate and screw fixation, and 8 (23.5%) received intramedullary nailing fixation. The follow-up protocol included clinical and radiologic evaluations performed at 15 days, 1 month, 3 months, 6 months, and 12 months after surgery. The selected outcome parameters for the 3 groups were as follows: visual analog scale for pain of the traumatized tibia, interval from surgery to weightbearing, average time required for fracture recovery, subjective and objective Ovadia-Beals scores, baropodometric examination at 12 months, walking recovery at 12 months, outcomes, and surgical complications. The endpoint assessment was set at 12 months. The results showed that incorrect reduction of a type A tibia fracture can lead to changes in the sagittal balance line for foot loading and pace training. In conclusion, these findings have shown that the experience of the surgeon in the reduction of the fracture and knowledge of the method of synthesis is essential.
Collapse
Affiliation(s)
- Gabriele Falzarano
- Orthopedic and Trauma Surgeon, U.O.C. Orthopedics and Traumatology, Azienda Ospedaliera "Gaetano Rummo", Benevento, Italy
| | - Giuseppe Pica
- Orthopedic and Trauma Surgeon, U.O.C. Orthopedics and Traumatology, Azienda Ospedaliera "Gaetano Rummo", Benevento, Italy
| | - Antonio Medici
- Orthopedic and Trauma Surgeon, U.O.C. Orthopedics and Traumatology, Azienda Ospedaliera "Gaetano Rummo", Benevento, Italy
| | - Giuseppe Rollo
- Orthopedic and Trauma Surgeon, U.O.C. Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy
| | - Michele Bisaccia
- Orthopedic and Trauma Surgeon, Orthopaedic and Traumatology Unit, Department of Surgical and Biomedical Science, Universital Hospital "S.M. Misericordia Hospital", Perugia, Italy
| | - Raffaele Cioffi
- Orthopedic and Trauma Surgeon, U.O.C. Orthopedics and Traumatology, Azienda Ospedaliera "Gaetano Rummo", Benevento, Italy
| | - Mario Pavone
- Orthopedic and Trauma Surgeon, School of Medicine and Surgery, Vasile Goldiș Western University of Arad, Arad, Romania
| | - Luigi Meccariello
- Orthopedic and Trauma Surgeon, U.O.C. Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy.
| |
Collapse
|
|
50
|
Tas DB, Smeeing DPJ, Emmink BL, Govaert GAM, Hietbrink F, Leenen LPH, Houwert RM. Intramedullary Fixation Versus Plate Fixation of Distal Fibular Fractures: A Systematic Review and Meta-Analysis of Randomized Controlled Trials and Observational Studies. J Foot Ankle Surg 2019; 58:119-126. [PMID: 30583773 DOI: 10.1053/j.jfas.2018.08.028] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Indexed: 02/03/2023]
Abstract
Intramedullary fixation (IMF) has been described as a minimally invasive alternative to open reduction and internal fixation for operative treatment of distal fibular fractures in case of compromised soft tissue or severe comorbidities. The objective was to compare postoperative complications and functional outcomes of intramedullary versus plate fixation (PF) in distal fibular fractures. A systematic review and meta-analysis was performed. The PubMed/MEDLINE, Embase, Cochrane, and CINAHL databases were searched for both randomized controlled trials and observational studies. A total of 26 studies was included, reporting on 1710 patients with a mean age of 51.6 years. Meta-analysis was performed on 8 comparative studies, including subgroup and sensitivity analyses on all outcomes. IMF was associated with significantly fewer wound related complications (odds ratio [OR], 0.11; 95% confidence interval [CI], 0.04 to 0.25; p < .01), implant removals (OR, 0.54; 95% CI, 0.31 to 0.93; p = .03), and nonunions (OR, 0.31; 95% CI, 0.15 to 0.62; p < .01). No differences were found regarding malunion (OR, 0.45; 95% CI, 0.17 to 1.21; p = .11) and the Olerud Molander Ankle Score for long-term functional outcome (mean difference, 9.56; 95% CI, 1.24 to 20.37; p = .08). Results of this study apply to a select group of patients, in which the advantages of minimal soft tissue damage by IMF are preferable to optimal fracture reduction by PF. IMF of distal fibular fractures resulted in fewer wound-related complications, implant removals, and nonunions compared with PF. Especially in elderly patients, patients with chronic comorbidity, and patients with compromised soft tissue, IMF may be preferred over PF.
Collapse
Affiliation(s)
- David B Tas
- Medical Student, Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Diederik P J Smeeing
- Surgical Resident, Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, The Netherlands; Surgical Resident, Department of Trauma Surgery, Antonius Hospital Utrecht, Utrecht, The Netherlands
| | - Benjamin L Emmink
- Surgical Resident, Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Geertje A M Govaert
- Trauma Surgeon, Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Falco Hietbrink
- Trauma Surgeon, Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Luke P H Leenen
- Medical Student, Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Roderick M Houwert
- Professor of Trauma, Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, The Netherlands; Trauma Surgeon, Utrecht Traumacenter, Utrecht, The Netherlands
| |
Collapse
|