Background: To determine the clinical outcomes following fibula nail fixation and to identify the indication for the use of fibula nails in lower limb fractures. Methods: Retrospective study of adult patients from 2 major trauma centers (MTCs) and 9 trauma units (TUs) who underwent fibula nail fixation for AO/OTA 44 fractures between January 1, 2018, and October 31, 2020. Outcome measures included infection, metalwork complications, nonunion or malunion, time to union, and length of inpatient hospital stay. Results: Ninety-five patients were included, with a mean age of 66 years; 57.9% of patients were female. The average body mass index was 30. Sixty-nine patients (72.6%) sustained a Weber B and 24 (27.4%) sustained a Weber C fracture. In addition, 26.3% were open fractures and all patients had soft tissue compromise affecting the lateral malleolus. The calculated infection rate for fibula nail was 4.2% and metalwork complication rate was 5.2%. The nonunion and malunion rate was 8.4% and rate of removal of hardware was 2.1%. The average time to union was 12.5 weeks, and length of inpatient stay was 9.4 days (SD 10). Conclusion: This multicenter study demonstrates that use of a fibula nail appears to be a safe approach to treating patients who have a physiologically higher risk of surgery, poor skin condition, and a complex fracture pattern.
Category: Trauma; Ankle Introduction/Purpose: Lower limb fractures account for a third of all orthopaedic injuries of which 22% are ankle fractures. With a gradual move toward minimally invasive surgery for ankle fractures, intramedullary implants have evolved over the years to dedicated fixation devices for fibula fractures. The aim of this study was to determine the clinical outcomes following fibula nail fixation and to identify the indication for the use of fibula nails in ankle fractures. Methods: A retrospective study of adult patients from 2 major trauma centers (MTCs) and 9 trauma units (TUs) who underwent fibula nail fixation for AO/OTA 44 fractures between January 1, 2018, and October 31, 2020 was conducted. Fracture were classified based on the Weber or AO/OTA classification. Operative fixation was performed using the Acumed Fibula Rod (Acumend Fibula Rod System, Hilsboro, OR, USA) and a minimally invasive direct approach to the lateral malleolsus with radiography-guided percutaneous screw insertion was used in all patients. The outcome measures included infection, metalwork complications, nonunion or malunion, time to union, and length of inpatient hospital stay. Results: Ninety-five patients were included, with a mean age of 66 years; 57.9% of patients were female. The average body mass index was 30. Sixty-nine patients (72.6%) sustained a Weber B and 24 (27.4%) sustained a Weber C fracture. In addition, 26.3% were open fractures and all patients had soft tissue compromise affecting the lateral malleolus. The calculated infection rate for fibula nail was 4.2% and metalwork complication rate was 5.2%. The nonunion and malunion rate was 8.4% and rate of removal of hardware was 2.1%. The average time to union was 12.5 weeks, and length of inpatient stay was 9.4 days (SD 10). Conclusion: This is the largest multicenter to date which demonstrates that use of a fibula nail appears to be a safe approach to treating patients who have a physiologically higher risk of surgery, poor skin condition, and a complex fracture pattern. The risks of wound and metalwork complicatons appear relatively low following fibula nail fixation in comparison to ankle ORIF's.
Category: Trauma; Midfoot/Forefoot; Sports Introduction/Purpose: Surgical treatment of Lisfranc fractures has evolved from arthrodesis or transarticular screw fixation to joint preserving modalities (suture buttons and/or dorsal spanning plates), the latter commonly requiring removal due to metalwork irritation and to restore motion at the 1st-MTPJ. Shape memory staples formed from Nitinol exploit its biomechanical properties of; low Young's modulus, super elasticity and high ductility. To produce a robust implant that generates greater compressive forces at its distal end compared to traditional 316L stainless steel compression staples. Permitting the construction of a rigid fixation for Lisfranc fractures that is achieved with transarticular screws or plate fixation, but is mobile and elastic as with suture buttons. This study aims to assess the surgical outcomes of staple fixation in acute Lisfranc fractures. Methods: A prospective study to assess for union and necessity for revision surgery was completed for consecutive Lisfranc fractures treated with Nitinol shape memory staple fixation from June 2020 at a single U.K. Level 1 Major-Trauma-Centre. All operations were performed or supervised by a single fellowship trained Major Trauma Foot & Ankle Surgeon through a EHL bed approach to access the base of the 2nd MT and cuneiforms. Relevant joints were debrided and reduced, held with K-wires and reduction clamps to allow for the placement of the staples. A triangular configuration for the placement of three staples (2nd MT to Middle Cuneiform, 2nd MT to Medial Cuneiform, Middle to Medial Cuneiform). Reduction of the Lisfranc complex was confirmed on intra-operative fluoroscopy. Patients were non-weight bearing for 4 weeks with appropriate VTE prophylaxis. Staples were placed so as to not penetrate the plantar cortex and inter-cuneiform instability was assessed and confirmed intra- operatively. Results: Results from 19 consecutive patients were analysed, consisting of 9 men 10 women, with a mean age of 44 years (19-76). Seven patients sustained high energy trauma. Mean time to theatre was 18 days (5-28) from date of injury. Mean total operative time was 70 minutes, (27-154) with an mean tourniquet time of 63 minutes. An mean length of follow-up was 13.5-months (range 6-20 months), with a 100% union rate on weight-bearing radiographs and no incidences of post-operative complications requiring further medical or surgical intervention. No patients reported symptomatic implant irritation which required consideration of metalwork removal. The average FADI score was 73/104 (70%) at longest follow-up. Conclusion: Nitinol shape memory staple fixation of Lisfranc fractures is safe and efficacious, removing the necessity for metalwork removal as is commonly seen with dorsal bridging plates whilst maintaining the structural rigidity of plate/trans-articular screw fixation at the same time as allowing for physiological motion at the 1st-MTPJ. Patient reported outcome measures of this technique demonstrate equitable outcomes to more conventionally used techniques. This is the largest series of shape memory alloy staple fixation of acute Lisfranc injuries the authors are aware of and demonstrates that this technique should be considered a part of a surgeons' armamentarium when treated Lisfranc injuries.
Ledderhose disease is a connective tissue disorder involving proliferation of fibrous tissue in the plantar fascia of the foot. Histologically identical manifestations exist in the hand (Dupuytren’s contracture) and penis (Peyronie’s disease), and collagenase injections are approved as a treatment in both, however not in Ledderhose, where the treatment of choice remains surgical resection. Surgery is associated with high rates of recurrence and need for further surgery, so alternative therapies should be sought. Due to their histological and physiological similarities, it is likely that therapies useful in Dupuytren’s and Peyronie’s would be useful in Ledderhose. Two previous case reports investigating collagenase injections for Ledderhose disease in adults have shown conflicting results; this study demonstrates the efficacy of collagenase injections in a paediatric patient at 1-year follow-up.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.