Retrospective Review of 200 Consecutive, Single Surgeon, Fibula Nails with Proximal and Distal Fixation

Abstract

Category: Trauma; Ankle Introduction/Purpose: Ankle fractures are one of the most common injuries presenting to orthopedic surgeons. Unstable ankle fractures require surgical intervention and the most common fixation method is the use of a plate and screw construct. However, this requires an extensive open incision, which potentially increases the risk of post-operative wound complications and the possibility of hardware irritation. The purpose of this abstract is to evaluate the clinical outcomes of the treatment of unstable lateral malleolar fractures using a fibula nail with both proximal and distal locking capabilities from our original cohort, and in our increased cohort of 200 consecutive single surgeon fibula nails using a mini open incision to anatomically reduce. Methods: We retrospectively reviewed 200 consecutive FibuLock Fibula Nail® fixation constructs (Arthrex, Naples, FL, USA) of a single surgeon in a private practice community hospital. Demographic, operative, clinical, and radiographic outcome data were analyzed. Results: The average follow-up time of the patients was 18.5 months. The demographics of the patients can be found in table 1. There were no cases of infection, loss of reduction, delayed union, or nonunion. All fractures healed. There were two cases of focal superficial epidermal lysis treated with local wound care, that did not require antibiotics. One patient required removal of the nail as a result of it being proud, which was an iatrogenic error. In our previously reported first 110 nails, we had to convert two fractures to plate fixation intraoperatively due to excessive comminution, which made the implantation more difficult. There were no further episodes of this in our next 90 cases due to adoption of plate assisted nail technique. Conclusion: The use of an intramedullary nail with a mini-open technique allows for anatomic fracture reduction and no-profile fixation, thus reducing the risk of wound complications and providing stable fixation. Our technique results in anatomic healing in nearly all patients. Also, there were no incidents of delayed or malunion and no postoperative loss of reduction. Our results demonstrated a very low complication rate compared to traditional plate fixation with good patient reported outcomes.