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Nail and screw construct fosters union of unstable fibular fractures
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MANCHESTER — A new surgical technique to fix unstable ankle fractures was associated with a 100% union rate and one postoperative infection, according to a presenter at the British Orthopaedic Association Congress 2012, here.
“On all three of the outcome measures that we used, we found good patient-reported outcomes and scores comparable to other cohorts with a far younger mean age,” Kate E. Bugler, BA, MRCS, specialty registrar of the Royal Infirmary of Edinburgh, in Edinburgh, United Kingdom, said.
Kate E. Bugler
Patients with unstable ankle fractures typically have comorbidities that negatively impact their fixation and outcomes, particularly older patients, she said. Lateral malleolar plates are bulky and associated with complications, according to the study abstract. Bugler said using Rush nails often failed to provide the necessary stability and were associated with shortening, lateral collapse of the fracture and other complications. This led Bugler and colleagues to develop a solution to mitigate the postoperative problems seen in these cases.
The recently developed procedure involves using a fibular nail [Acumed; Hampshire, UK].
Bugler and colleagues have used the technique on 21 patients to date with a mean age of 55 years. Outcomes were assessed with the Olerud and Molander score, the SF12 and the American Academy of Orthopaedic Surgeons Foot and Ankle Outcome Score.
“The current technique employs a distal locking screw for a firm grasp of the distal fragment and a screw across the syndesmosis to maintain length and provide a stable lateral buttress,” Bugler said.
The selection of the optimal method of grasping the distal fracture fragment that would maintain length and provide a stable lateral buttress proved the most difficult aspect of developing the intramedullary fibular nailing technique, she said.
Minimal tissue dissection and a small incision are among the advantages of the technique, according to the abstract.
References:
Bugler KE, Hardie AR, Watson CD, et al. The Acumed fibular nail for treatment of unstable ankle fractures: Development of technique. Paper #156. Presented at the British Orthopaedic Association Congress 2012. Sept. 11-14. Manchester.
Bugler KE, Hardie AR, Watson CD, et al. The treatment of unstable fractures of the ankle using the Acumed fibular nail: Development of a technique. J Bone Joint Surg Br. 2012;94(8):1107-1112.
