Abstract
Introduction
The optimal treatment of elderly patients with unstable ankle fractures is a widely contested and as yet unresolved issue. Whereas the AO technique of anatomical reduction and plate fixation has been shown to give good functional results it is associated with a wound complication rate of up to 40%. This has led some surgeons to believe the risks of operative intervention are too great.
The fibula nail is an intra-medullary device with the benefit of requiring minimal soft-tissue dissection. It provides lateral column support over a greater area than the standard plate.
The study aims were to assess the clinical and radiographic outcome of a cohort of patients managed with the Fibula Nail (Acumed).
Methods
A prospectively collected group of 36 patients with an unstable Weber B or C fracture were managed with a fibula nail. Outcome measures at one-year follow-up were Olerud and Molander ankle scores, radiographic measurements and complications.
Results
At one-year follow-up the average Olerud and Molander score was 89/100. Four patients had died and none were lost to follow-up. Twenty-nine patients had normal radiographic measurements, one required a fusion due to fixation failure and two had signs of osteoarthritis. There were two lateral wound infections which both settled without metal work removal.
Conclusions
Our case series has demonstrated similar one-year clinical and radiographical results for the fibular nail as previously published with the standard plate and screw technique with few wound complications.
The results do indicate the fibula nail has a role in the management of this notoriously difficult fracture. Whether this cohort continues to do well however is unknown and will be the focus of future research.
