SLR - August 2023 - Jessica Singh, DPM
Title: Fibula nail versus Locking Plate Fixation—A Biomechanical StudyReference: Kohler FC, Schenk P, Nies T, Hallbauer J, Hofmann GO, Biedermann U, Kielstein H, Wildemann B, Ramm R, Ullrich BW. Fibula Nail versus Locking Plate Fixation—A Biomechanical Study. Journal of Clinical Medicine. 2023; 12(2):698.
Level of Evidence: Level IV study
Reviewed By: Jessica Singh, DPM
Residency Program: Hoboken University Medical Center, Hoboken, NJ
Podiatric Relevance: Open reduction and internal fixation has been the standard of treatment when dealing with ankle fractures, however, patients may have comorbidities that may increase their risk of complications. Now, there is a minimally invasive treatment option for patients with the fibular nail that can minimize these complications and allow them to weight bear immediately post-operatively. This study compares the stability and stiffness of fixation using plate and screws compared to the fibular nail.
Methods: Eight fresh, frozen cadaver legs were used and a fibular osteotomy was performed to simulate a PER 4 or Weber C ankle fracture with the deltoid and syndesmosis disrupted. Of the 8 legs, half were fixated randomly using plate and screws and the other half were fixated using the fibular nail. Both groups had 2 syndesmotic screw fixation construct. A pneumatic device was used to test the biomechanical strengths of each group by applying axial and rotational forces. Measurements included the angle of rotation between the tibia and fibula (ROM), rotational stiffness (RS), and diastasis between the tibia and fibula.
Results: Comparing the two fixations, no significant difference with range of motion and in general the load level showed no significant effect on the ROM. The nail fixation showed significantly higher normalized rotational stiffness values than the plate fixation for the mean of all force levels. There was no significant difference between the two and their influence on the diastasis for all forces.
Conclusions: Both fixation techniques achieved comparable biomechanical stability values whereas the nail offers an advantage over the plate for rotational stability thus allowing patients to fully weight bear immediately. This is especially beneficial for patients who are unable to adhere to non-weightbearing protocol and possibly have limited care post-operatively once they are discharged home. The nail also allows for lower wound healing complications as it is more of a minimally invasive fixation method. Overall, the fibular nail presents with some advantages over traditional ORIF in certain circumstances.