Patient Reported Outcomes with the Use of Fibular Nail Fixation, Retrospective Review of 41 Cases

Abstract

Category: Trauma; Ankle Introduction/Purpose: Traditionally, open reduction and internal fixation of unstable lateral malleolus fractures with plate and screw constructs has been considered the gold standard treatment. More recently, the use of an intramedullary fibula nail has gained popularity as an alternative treatment method using a mini open incision to obtain anatomic reduction. The minimally invasive nature of this technique and the no profile load bearing/sharing implant is reported with very low complication rates and a much lower incidence of implant irritation and removal. We report our surgical and patient reported outcomes for a cohort of single surgeon consecutive fibula nails with proximal and distal locking fixation. Methods: We retrospectively reviewed prospectively collected data on 41 patients that were implanted with the Fibulock® Fibula Nail (Arthrex, Naples, Florida, USA). All nails were implanted by a single surgeon. Intraoperative reduction quality was recorded, and patients were followed post operatively with radiographs that were assessed for maintenance of reduction, healing, and complications. Patient reported outcome questionnaires (PROMs) were collected preoperatively and at 3, 6, 12, and 24 months postoperatively. The Foot and Ankle Ability Measure (FAAM) assessed the patient’s functional status in terms of activities of daily living and sports. The Visual Analogue Score (VAS) was also collected. Results: All 41 patients had one- to two- year follow-up (14.68 months ± 5.92). Demographics are listed on table 1. Forty of the patients were reduced via mini open incision and one was reduced closed. There were no conversions to a plate, no intraoperative complications, and no cases of loss of reduction postoperatively. No patient required revision surgeries, no cases of delayed union or nonunion, and zero superficial or deep postoperative infections. Statistical analysis revealed a significant difference between preoperative and postoperative FAAM scores overall (+67.52, p < 0.001), within activities of daily living (+68.07, p < 0.001), and sport (+65.95, p < 0.001). Also, there was a significant difference between preoperative VAS and postoperative VAS (+4.73, p < 0.001). Conclusion: Our results support existing literature that fixation of fibula fractures with an intramedullary nail with proximal and distal locking capabilities is an alternative option to a plate and screw construct, with a very low incidence of hardware related complications requiring removal, and favorable patient reported outcomes.