Internal fixation of the fibula in ankle fractures. A prospective, randomized and comparative study: Plating versus nailing

Orthopaedics & Traumatology Surgery & Research (Impact Factor: 1.26). 04/2014; 100(4). DOI: 10.1016/j.otsr.2014.03.005
Source: PubMed


Open reduction and internal plate fixation of the fibula is the gold standard treatment for ankle fractures. The aim of this study was to perform a prospective randomized study to compare bone union, complications and functional results of two types of internal fixation of the fibula (plating and the Epifisa(®) FH intramedullary nail).
Inclusion criteria were: closed fractures, isolated displaced fractures of the lateral malleolus, inter- and supra-tubercular bimalleolar fractures, and trimalleolar fractures. This study included 71 patients (mean age 53±19): plate fixation group (n=35) and intramedullary nail fixation group (n=36). In seven cases, intramedullary nailing was technically impossible and was converted to plate fixation (the analysis of this sub-group was performed independently). Two patients died and two patients were lost to follow-up. The final comparative series included 32 cases of plate fixation and 28 cases of intramedullary nail fixation. Union, postoperative complications and Kitaoka and Olerud-Molander functional scores were analyzed after one year of follow-up.
There was no significant difference in the rate of union (P=0.5605) between the two types of fixation. There were significantly fewer complications (7% versus 56%) and better functional scores (96 versus 82 for the Kitaoka score; 97 versus 83 for the Olerud-Molander score) with intramedullary nailing than with plate fixation.
Intramedullary nailing of the lateral malleolus in non-comminuted ankle fractures without syndesmotic injury is a reproducible technique with very few complications that provides better functional results than plate fixation.
II (randomized prospective study).

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    ABSTRACT: Treatment of adult tibiofibular fractures, especially severely comminuted fractures, is technically challenging due to the lack of reduction markers and difficulty in restoring the alignment. Fixation of the fibula can facilitate reduction of the tibia fracture and restoration of the lower-extremity alignment. However, there are few literatures mentioned using intramedullary nail fixation for fibular fractures. Twenty-three cases of tibiofibular fractures were treated with elastic nails fixation fibular fractures and intramedullary nail or plate stabilization tibial fractures between January 2012 and December 2012. Adult tibiofibular fractures with fibular neck fractures or fibular fracture line apart from the ankle joint surface within 8 cm was ruled out. There were 19 males and 4 females with an average age of 41 years (range, 21-59 years). The injury causes included 11 falls and 12 traffic accidents. The left side was involved in 11 cases and the right side was involved in 12 cases. Seventeen cases were closed fractures and 6 cases were open fractures, all were Gustilo type I and II fractures. According to the AO classification, six fractures were defined as type 42A, 11 as type 42B, and 6 as type 42C. The average interval between injury and surgery was 5.8 d (range, 3-22 d). The operation time of elastic nails fixation fibular fractures was 24 minutes (range, 15-42 minutes). Primary wound healing was achieved in all patients. No complications such as infection and wound necrosis occurred. Twenty-one patients were followed up for a mean follow-up period of 16.3 months (range, 12-26 months). The mean duration of fracture healing in the radiographs was 4.1 months (range, 3-8 months). No recurrent fracture dislocation and breakage of implant were observed. At the last follow-up visit, the lower-extremity alignment was excellent. Two degrees of varus deformity was found in 3 cases, and 2 degrees of valgus deformity was observed in 2 cases, but there were no serious varus or valgus deformity affecting the lower-extremity function or causing pain. The results of Tornetta's ankle function scoring were excellent in 17 cases, good in 3 cases, and fair in 1 case; and the good-to-excellent rate was 95.2%. In the case of adult tibiofibular fractures, elastic nails fixed fibular fracture is helpful to maintain and adjust the lower limbs axis, help tibial fracture reduction, and increase stability.
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