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Fibular nail fosters union of unstable fibular fractures
Investigators from the United Kingdom used the fibular nailing technique in 21 patients, citing a small incision and minimal tissue dissection among its advantages.
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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, 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 at Royal Infirmary of Edinburgh, in Edinburgh, United Kingdom, said.
Older patients with unstable ankle fractures often have comorbidities that negatively impact their fixation and outcomes, she said.
Seeking a solution
Lateral malleolar plates are bulky and associated with complications, according to the study abstract. Bugler said previous attempts at intramedullary fixation of the fibula 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, United Kingdom].
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.
Fibular nail and distal locking screw
“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 during her presentation.
Minimal tissue dissection and a small incision are among the advantages of the technique, according to the abstract. – by Susan M. Rapp
- References:
- Bugler KE. J Bone Joint Surg Br. 2012;doi: 10.1302/0301-620X.94B8.28620.
- Bugler KE. Paper #156. Presented at: British Orthopaedic Association Congress; Sept. 11-14, 2012. Manchester.
- For more information:
- Kate E. Bugler, BA, MRCS, can be reached at Orthopaedic Trauma Unit, Little France, Edinburgh EH16 4SA, United Kingdom; email: kate.bugler@doctors.org.uk.
Disclosure: Although none of the authors has received or will receive benefits for personal or professional used from a commercial party related directly or indirectly to the subject of this article, benefits have been or will be received but will be directed solely to a research fund, foundation, educational institution, or other non-profit organization with which one or more of the authors are associated.