Fluoroscopy-guided reduction and fibular nail fixation to manage unstable ankle fractures in patients with diabetes

Ashman, Bradley D; Kong, Christopher; Wing, Kevin; Penner, Murray; Bugler, K.E.; White, T O; Younger, Alastair

doi:10.1302/0301-620x.98b9.37140

Cited by 31 publications

(24 citation statements)

References 26 publications

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“…There is mounting clinical evidence that intramedullary fibular nail fixation for unstable ankle fractures compares favorably to traditional plating techniques due to lower wound complication rates. [2][3][4]9,21,22,28 However, because of limited biomechanical evidence, some have questioned the strength of intramedullary fixation, especially in weaker, osteoporotic bone, and against a rotational force where historically intramedullary devices have failed. 23 A reproducible testing regime was designed incorporating a simulated cadaveric SER IV ankle fracture stressed in torque under a constant axial load.…”

Section: Discussionmentioning

confidence: 99%

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Biomechanical Comparison of Intramedullary Fibular Nail Versus Plate and Screw Fixation

et al. 2017

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Section: Discussionmentioning

confidence: 99%

“…11,17 Recent clinical studies in diabetic and elderly patients with unstable ankle fractures have demonstrated that fibular nail fixation results in fewer wound complications and infections. 3,28 Furthermore, the fibular nail should have superior strength by virtue of its intramedullary location.…”

Section: Introductionmentioning

confidence: 99%

Biomechanical Comparison of Intramedullary Fibular Nail Versus Plate and Screw Fixation

et al. 2017

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“…Within 22 publications that investigated fibular nail fixation, this implant was analyzed in 8 studies. 1,3,[6][7][8]11,22,29 The nail is made of titanium and allows secure cross-locking including distal anteroposterior locking screws and lateral to medial trans-implant tibial-fibular syndesmosis screws. This design allows fragment fixation in addition to fibular length and rotational stability.…”

Section: Historical Considerationsmentioning

confidence: 99%

Fibular Nail Fixation: Topical Review

Bäcker

2019

Foot Ankle Int.

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Background: Intramedullary implants have been used historically in long bone fractures with success. In recent years, a variety of intramedullary implants for the treatment of fibular fractures have been investigated. These various implants have not been assessed together in a cohesive manner. In this review, we assess implants used for intramedullary fixation of fibular fractures with respect to implant design and clinical results. Methods: A comprehensive systematic literature review for intramedullary implants in fibular fractures was performed. All publications that assessed intramedullary fibular implants were reviewed. In total, 11 different intramedullary nails were found. Clinical results obtained from these studies were reviewed. Results: The intramedullary implants used for fibular fracture fixation generally fell into one of 3 categories: an unlocked longitudinal strut, an implant roughly equivalent to a large screw, or a more traditionally locked intramedullary nail. Reported clinical results were generally good, although inconsistent outcome reporting greatly limited comparison between studies. Complication rates varied with the implants but were generally low. Conclusion: Intramedullary implants for fibular fracture stabilization have changed over the years to improve stability. Although clinical results are limited, data suggest that these implants are safe and can potentially approximate more traditional implants. Level of Evidence: Level II, systematic review.

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“…The eventual amputation rate following deep infection was 13% (8% for closed fractures, 33% for open fractures). A retrospective case series in British Columbia (Canada) & Edinburgh (UK) published by Ashman et al 30 looked at the complication profile of the Acumed Fibula Rod System® (Acumed, New Jersey, USA) in 24 patients with diabetes deemed high risk (having HbA1c > 6.5 but without history of Charcot). They gave an overall wound infection rate of 8.3% which they compared to the current literature and found to be equivocal.…”

Section: Surgical Fixation (Supplementary Fixation or Alternative Fixation)mentioning

confidence: 99%

Current concepts and challenges in managing ankle fractures in the presence of diabetes: A systematic review of the literature

Nash¹,

Hester

2021

Journal of Clinical Orthopaedics and Trauma

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Background: Ankle fractures in diabetic patients are known to have an increased morbidity. This systematic review aims to evaluate the current evidence in terms of risk profile and inform treatment options. Methods: Following the methodology of the Cochrane collaboration, an extensive literature search was conducted. Outcomes included, complications, operative and non-operative management and early weight-bearing. Results: A total of 40 studies were included. Complication rates were higher in diabetic patients and more so in poorly controlled diabetes, IDDM, or "complicated" diabetes. Supplementary fixation was associated with lower complication rates. Regarding early weight-bearing, similar results to nondiabetics in the stable fracture pattern were found providing there was no evidence of neuropathy. Conclusion: Diabetes, especially complicated diabetes, presents an increased risk of complications. However non operative management of diabetic ankle fractures do poorly, and with the use of 'ORIF plus' techniques there is no increase in complications from early fixation. The use of external fixation for definitive fixation should be minimised as it is associated with high complication rates.

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Fluoroscopy-guided reduction and fibular nail fixation to manage unstable ankle fractures in patients with diabetes

Abstract: Fluoroscopy-guided reduction and fibular nail fixation of unstable ankle fractures in patients with diabetes was associated with a low incidence of wound and overall complications, while providing effective surgical fixation. Cite this article: Bone Joint J 2016;98-B:1197-1201.

Cited by 31 publications

References 26 publications

Biomechanical Comparison of Intramedullary Fibular Nail Versus Plate and Screw Fixation

Biomechanical Comparison of Intramedullary Fibular Nail Versus Plate and Screw Fixation

Fibular Nail Fixation: Topical Review

Current concepts and challenges in managing ankle fractures in the presence of diabetes: A systematic review of the literature

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