Safety and Efficacy of Surgical Fixation of Fibula Fractures Using an Intramedullary Nail: A Retrospective Observational Cohort Study in 30 Patients

SLR - December 2019 - Aasin Tareen

Reference: Boni G, Sanchez GT, Arliani G, Zelle BA, Pires RE, Dos Reis FB. Safety and Efficacy of Surgical Fixation of Fibula Fractures Using an Intramedullary Nail: A Retrospective Observational Cohort Study in 30 Patients. Patient Saf Surg. 2019;13:31. Published 2019 Oct 15. doi:10.1186/s13037-019-0211-7

Scientific Literature Review

Reviewed By: Aasin Tareen, DPM
Residency Program: Cedars Sinai Medical Center – Los Angeles, CA

Podiatric Relevance: Ankle fractures account for nearly one-fourth of all lower extremity bone injuries. In spite of this, it should be noted that these are frequent and significant presentations in many podiatric practices. Open reduction and internal fixation (ORIF) remains the standard treatment for displaced unstable ankle fractures. Plate fixation represents the most frequently used instrumentation option in fibula fractures and promising outcomes have been published. Currently, intramedullary nailing techniques have been suggested as a practical alternative resulting in less soft tissue disruption. The purposes of this study were 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: This was a retrospective study reviewing a total of 30 skeletally mature patients with unstable ankle fractures who underwent intramedullary fixation of their fibula fractures from February 2016 to July 2017. All patients participating in this study were provided full disclosure and written informed consent was obtained from all subjects enrolled. The inclusion criteria for enrollment in this study included skeletally mature patients with unstable fibula fractures (Danis-Weber type B and type C) treated with an intramedullary nail. Skeletally immature patients, as well as, patients who were unwilling to provide consent, were excluded from this 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: A total of 30 patients (12 females, 18 males), with unstable fibular fractures were surgically treated using this fixation method. All patients were operated on within 24 hours of their injury. A total of 17 fractures (56.7 percent) presented as lateral malleolus fractures and 13 fractures (43.3 percent) presented as bimalleolar fractures. 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: The outcomes attained in this study compare constructively with previously reported data. Statistics propose that the use of a fibular nail in patients with unstable ankle fractures was linked with a low complication rate and satisfactory clinical outcomes. This study shows that intramedullary nail fixation of unstable ankle fractures represents a safe surgical procedure. The strength of this study is the single-center experience with a homogenous patient population and a standardized surgical and rehabilitation protocol. Limitations of this study lie in its retrospective design. In spite of this, this patient series demonstrates promising outcomes associated with intramedullary nail fixation of unstable fibula fractures. It is recommended that intramedullary nail fixation of fibular fractures to be a safe procedure with a low complication rate.