Can Locked Fibula Nail Replace Plate Fixation for Treatment of Acute Ankle Fracture? A Systematic Review and Meta-Analysis

Guo, Wenxuan; Wu, Fan; Chen, Wenhuan; Tian, Kun; Zhuang, Rujie; Pan, Yu

doi:10.1053/j.jfas.2022.10.003

Cited by 9 publications

(10 citation statements)

References 42 publications

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“…Based on these findings, after intramedullary fixation, syndesmosis reduction was observed, not totally satisfactory in most patients, leading to the hypothesis that this may not be reflected in a worse functional outcome in the studied population. These findings align with previous results in the literature, which demonstrated that the surgical treatment of ankle fractures through an intramedullary nail results in satisfactory functionality (14) .…”

Section: Discussionsupporting

confidence: 92%

“…This parameter is relevant since an inadequate reduction can trigger complications, including premature arthrosis, with worse clinical outcomes (15) . In addition, it is known that nail treatment, due to its lower aggressiveness compared to open reduction and internal fixation with plate and screws, is associated with a lower inci dence of skin complications (14,16) , with surgical wound dehiscence being the main complication, occurring more frequently in diabetic patients (17) .…”

Section: Discussionmentioning

confidence: 99%

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Treatment of ankle fractures with fibular nail: clinical and imaging evaluation

Gomes,

Magalhães

et al. 2024

J Foot Ankle

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Objetivo: Realizar uma avaliação clínica e imaginológica de pacientes com fraturas do tornozelo submetidos a osteossíntese com haste bloqueada, analisando o encurtamento da fíbula e redução tíbio-talar através de parâmetros de imagem bem estabelecidos na literatura. Métodos: Foram selecionados 25 pacientes operados pela técnica de haste intramedular bloqueada de fíbula, submetidos a cirurgia entre abril de 2018 e dezembro de 2022. Os pacientes tinham idade acima de 55 anos, com risco aumentado para complicações de cicatrização. Para avaliação clínica foram usados: escore AOFAS e escala visual analógica. Os parâmetros de imagem utilizados foram o ângulo talocrural, o espaço claro medial e a linha tibiofibular. Resultados: Foi avaliado escore AOFAS com média de 83,48 (± 15,34), com mínimo de 40 e máximo de 98 pontos. Na escala visual analógica de dor, a média foi 2,56 pontos (± 2,50), com mínimo de 0 e máximo de 8. Na linha anterior tibiofibular, a diferença entre a média e o valor de referência (2 mm) foi de 0,38 mm. Sobre o espaço claro medial, 100% apresentou valores dentro da referência (até 4 mm). Na análise do ângulo talocrural, a média das diferenças obtidas entre os valores de cada paciente e a referência se situaram dentro dos valores normais. Conclusão: A osteossíntese de fraturas do tornozelo com haste intramedular bloqueada é uma excelente alternativa nos pacientes idosos e com risco aumentado para complicações, conduzindo a bons resultados funcionais em seguimento de médio prazo, apesar de não mostrar uma redução satisfatória de redução da sindesmose na maioria dos casos

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Treatment of ankle fractures with fibular nail: clinical and imaging evaluation

Gomes,

Magalhães

et al. 2024

J Foot Ankle

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“… 3 - 6 , 17 This study supports current literature that suggests that the use of a fibula nail may be a better alternative than the traditional plate fixation currently used especially for select patients. 10 We chose to perform arthroscopy in 170 (84%) of our patients. Malleolar fractures commonly have concomitant chondral or osteochondral defects, many of which are missed on radiographs and CT scans.…”

Section: Discussionmentioning

confidence: 99%

Use of Fibula Nails With Proximal and Distal Fixation

Rodriguez-Materon,

Trynz,

Fanfan

et al. 2024

Foot & Ankle Orthopaedics

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Background: Ankle fractures are a frequent injury in the adult population and a quarter of all ankle fractures are classified as unstable, requiring surgical intervention. Plate-and-screw construct is the traditionally used fixation method for fibula fractures. The use of an intramedullary nail is an alternative fixation method, with current literature supporting very low complication rates and hardware removal surgeries. The purpose of this study was to evaluate the outcomes, including complication rates and implant removal rates, using a fibula nail with both proximal and distal fixation capabilities by an experienced surgeon. Methods: We retrospectively reviewed 203 consecutive fibula nail cases from a single surgeon using a mini-open technique for anatomic reduction. Demographic, operative, clinical, and radiographic outcome data were analyzed, specifically examining complication rates and need for implant removal. Results: The average follow-up was 18.8 months (6-54 months). All fractures healed. We identified 2 cases of superficial wound infection, 1 superficial peroneal nerve irritation, and 1 case of implant removal. In the first 110 cases, 2 fractures were converted to a plate intraoperatively prior to a technique modification which has prevented this occurrence. No deep infection, delayed union, or nonunion occurred. Conclusion: Our data support that fibula nails with proximal and distal locking capabilities offer an alternative to plating with the potential for lower complication rates and lower need for implant removal. Level of evidence: Level IV, case series.

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“…A systematic review with 627 patients treated with a locked IN stated a consolidation rate of 98% with an infection rate of 1% and skin necrosis in 0.6% ( 41 ). A recent meta-analysis consisting of four randomized controlled trials with 359 patients comparing IN to ORIF demonstrated fewer wound-related complications and a better functional short-term 3-month-follow-up for the IN group but no significant differences regarding the overall complications, midterm functional outcome and quality of reduction ( 42 ).…”

Section: Treatment Optionsmentioning

confidence: 99%

Ankle fractures in the elderly: Do we have new concepts?

2023

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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.

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Can Locked Fibula Nail Replace Plate Fixation for Treatment of Acute Ankle Fracture? A Systematic Review and Meta-Analysis

Cited by 9 publications

References 42 publications

Treatment of ankle fractures with fibular nail: clinical and imaging evaluation

Treatment of ankle fractures with fibular nail: clinical and imaging evaluation

Use of Fibula Nails With Proximal and Distal Fixation

Ankle fractures in the elderly: Do we have new concepts?

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