The role of intramedullary fixation in ankle fractures – A systematic review

Jordan, Robert W.; Chapman, Anna W.P.; Buchanan, Donald; Makrides, Panayiotis

doi:10.1016/j.fas.2016.04.004

Cited by 43 publications

(31 citation statements)

References 39 publications

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“…Surprisingly, some of the SF-36 scales in our series trended even higher than in the normative patient population. The safety data recorded in this study are also in line with recent publications reporting relatively low complication rates associated with the use of a locked intramedullary fibular nail [20][21][22][23].…”

Section: Discussionsupporting

confidence: 89%

Safety and efficacy of surgical fixation of fibula fractures using an intramedullary nail: a retrospective observational cohort study in 30 patients

et al. 2019

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Background Open reduction and internal fixation remains the standard treatment for displaced unstable ankle fractures. Plate fixation represents the most frequently used instrumentation option in fibula fractures and favourable outcomes have been reported. Recently, intramedullary nailing techniques have been suggested as a viable alternative resulting in less soft tissue disruption. The objectives of this study are to describe the surgical technique and to evaluate the safety and efficacy of using an intramedullary nail in patients undergoing surgical fixation of their fibula fracture. Methods A total of 30 skeletally mature patients with unstable ankle fracture who underwent intramedullary fixation of their fibula fractures from February 2016 to July 2017 were included in this retrospective study. Patients were evaluated using the Short Form-36 (SF-36) and the American Orthopaedic Foot and Ankle Society (AOFAS) at 18 months after surgery. Results All patients went on to fracture union. Two patients required a secondary surgical procedure. No patient included in this series developed any wound complications. The mean Physical Component Summary (PCS) of the SF-36 was 53.90 ± 13.3 and the mean Mental Component Summary Score (MCS) was 52.63 ± 11.12. The AOFAS subscale scores were 34.67 ± 1.03 for pain, 42.40 ± 0.2997 for function and 9.50 ± 0.2785 for alignment. Conclusions Our study demonstrates promising outcomes associated with intramedullary nail fixation of unstable fibula fractures. We recommend intramedullary nail fixation of fibula fractures to be a safe procedure with a low complication rate. Level of evidence Level 4 retrospective case series.

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Section: Discussionsupporting

confidence: 89%

Safety and efficacy of surgical fixation of fibula fractures using an intramedullary nail: a retrospective observational cohort study in 30 patients

et al. 2019

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“…The use of modern fibular locking nails for unstable ankle fractures is gaining popularity due to its load sharing and rotationally stable properties. [23][24][25][26] In the past decade, there is a growing body of evidence to support its use, particularly in elderly patients who have a compromised soft tissue envelope that may be at risk with traditional fixation. [26][27][28][29] This study reviewed the outcome following ankle fracture treatment with the FRS in a non-designer level I major trauma setting.…”

Section: Discussionmentioning

confidence: 99%

Fibular nails for open and closed ankle fractures: Results from a non-designer level I major trauma centre

Al-Obaidi

Wiik

Bhattacharyya

et al. 2019

J Orthop Surg (Hong Kong)

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To evaluate the outcome of a fibular nail in the treatment of open and closed unstable ankle fractures in a nondesigner centre. Methods: In a retrospective cohort study, a total of 39 ankle fractures (14 open and 25 closed) treated with a locking fibular nail were evaluated between 2012 and 2015 in a non-designer level I major trauma centre. Postoperative radiographs were analysed to assess the quality of reduction (McLennan and Ungersma marking system), fracture union and complications. Three patient reported outcome scores (Olerud and Molander score (OMAS), American Association of Orthopaedic Surgeons (AAOS) foot and ankle score and 12-Item Short Form Survey (SF-12)) were collected to obtain an overall measure of the patient's physical and mental outcome. Results: The adequacy of reduction data was available for 38 of 39 cases; 33 (87%) achieved good, 3 (8%) fair and 2 (5%) poor ratings, based on the McLennan and Ungersma marking system. Thirty-five (12 open and 23 closed) patients were available for initial follow-up. Five (14.3%) of 35 had documented complications (2 of 12 in the open cohort and 3 of 23 in the closed cohort). All fibular fractures treated with the fibular nail went on to unite. Twenty-three (66%) of 35 patients were available at 1-year followup for measurement of objective outcome. The combined mean OMAS for both groups was 53.7 (0-85) with statistically better results (59.5 (25-85) vs. 37.3 (0-75)) in favour of the closed versus open injuries, respectively. The mean AAOS score was also statistically better for the closed group than the open, 70.3 (30-95) versus 46.6 (20-77), respectively. The mean SF-12 score (physical component) was 40 (21.6-52.4) in the closed group versus 36.1 (19.4-51.5) in the open group; the mean mental component was 42.5 (26.6-54.3) in the closed group versus 38.8 (28.4-60.5) in the open group, these however were not statistically different. Conclusion: Fibular nails are an effective alternative for the treatment for both closed and open unstable ankle fractures with soft tissue compromise.

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“…The option of internal fixation was based on factors such as fractures' state, comorbidity, and skin condition. Theoretically, a locking plate has a potential advantage in osteoporotic bone, provides sufficient strength to resist pullout, and this fixation allows screws to improve the stability of construction and facilitate bridging fixation, helping to maintain the reduced calcaneus morphology (29,30). In particular, the locking plate is fit for Sanders type II and III fractures (31).…”

Section: Discussionmentioning

confidence: 99%

The epidemiology and clinical features of calcaneus osteomyelitis following calcaneus fracture: a retrospective study of 127 cases

Huang¹,

Guo²,

Zhu³

2021

Ann Palliat Med

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Background: To analyze the epidemiology and features of calcaneus osteomyelitis following open reduction and internal fixation (ORIF) after closed calcaneus fracture.Methods: We retrospectively analyzed 127 cases who were diagnosed with calcaneal osteomyelitis following ORIF via the extended lateral "L-shaped" approach after closed calcaneus fracture between March 2016 and August 2019 in our hospital. We analyzed participant demographics including gender, age, body mass index (BMI), trauma mechanism, Sanders classification, co-morbidity, time between initial injury and surgery, operating time, soft tissue stripping tools, tourniquet pressure, bone grafting option, internal fixation option, presence of bleeding after tourniquet deflation, and drainage option.Results: The majority of cases (n=127) were male (4.5 times more than female gender), at a ratio of 4.47:1.Falling from height was the main trauma mechanism (79.53%), followed by traffic accident (14.17%), and jumping (6.3%). A total of 51 cases (40.16%) were left-side fractures, and 76 (59.84%) were right-sided.According to the Sanders classification, 12 cases were type II (9.45%), 61 cases were type III (48.03%), and 54 cases were type IV (42.52%). There were 25 participants with the co-morbidity of type 2 diabetes mellitus (19.69%), 7 with hypertension (5.51%), and 1 case each of psoriasis and sicca syndrome (0.8%). The mean time to surgery was 4.7 days (4-9 days), and 123 participants (96.85%) were treated within 7 days. The mean operating time was 102.1 min (75-135 min). Forty-four participants (34.65%) received the conventional scalpel and 83 participants (65.35%) the electric scalpel during soft tissue stripping intraoperatively. The mean tourniquet pressure was 432.3 mmHg (350-550 mmHg). Autologous bone grafting was observed in 6 cases (4.72%), allograft bone grafting in 11 cases (8.67%), and OsteoSet grafting in 7 cases (5.51%).A locking plate was used in 114 cases (89.76) while anatomical plate in 13 cases (10.24%). A total of 27 participants (21.26%) bled after tourniquet deflation. Drainage tubes were applied in 30 participants (23.62%) while rubber drainage strips in 5 participants (3.94%).Conclusions: Young males dominated the calcaneus osteomyelitis following traumatic calcaneus fracture cohort in this study. A fall from height was the most frequent trauma mechanism. The presence of severe calcaneus fracture, Sanders type III (48.03%) and type IV (42.52%), were the common fracture types in this population group.

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The role of intramedullary fixation in ankle fractures – A systematic review

Cited by 43 publications

References 39 publications

Safety and efficacy of surgical fixation of fibula fractures using an intramedullary nail: a retrospective observational cohort study in 30 patients

Safety and efficacy of surgical fixation of fibula fractures using an intramedullary nail: a retrospective observational cohort study in 30 patients

Fibular nails for open and closed ankle fractures: Results from a non-designer level I major trauma centre

The epidemiology and clinical features of calcaneus osteomyelitis following calcaneus fracture: a retrospective study of 127 cases

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