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Intramedullary fixation versus anatomically contoured plating of unstable ankle fractures: a randomized control trial

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Abstract

Aim

This study compared functional outcomes between anatomical shaped fibular plates and intramedullary nail fixation of adult patients who sustained unstable ankle fractures.

Methods

A prospective randomized control trial was conducted between November 2013 and December 2016 on patients that presented with an unstable ankle fractures. They were randomized into a plate-and-screw group and a fibula nail group. At each post-operative visit the wounds were reviewed, and specific outcome measures were recorded, which included (i) the patient reported outcome measure (PROM) Olerud and Molander functional score, (ii) the Grimby score, (iii) swelling around the malleoli, (iv) plantar flexion, (v) dorsiflexion, (vi) inversion, and (vi) eversion.

Results

Significant differences were observed in scar size (p < 0.001) and screening time (p < 0.001) whilst no differences were observed in functional and PROM measures. Although not statistically significant, of clinical value is one deep infection that occurred in the plate group, whilst no infections occurred in the nail group.

Conclusion

Both fixation methods yielded very similar functional results with differences only in scar size, screening time and swelling. Although none of these warrant a change in surgical decision-making processes, taken together, these factors potentially influence the decisions made in terms of surgical modalities used.

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References

  1. Daly PJ, Fitzgerald RH, Melton LJ, Ilstrup DM (1987) Epidemiology of ankle fractures in Rochester, Minnesota. Acta Orthop Scand 58:539–544

    Article  CAS  Google Scholar 

  2. Court-Brown CM, McBirnie J, Wilson G (1998) Adult ankle fractures--an increasing problem? Acta Orthop Scand 69:43–47

    Article  CAS  Google Scholar 

  3. Toth MJ, Yoon RS, Liporace FA, Koval KJ (2017) What’s new in ankle fractures. Injury 48:2035–2041. https://doi.org/10.1016/j.injury.2017.08.016

    Article  PubMed  Google Scholar 

  4. Schepers T, De Vries MR, Van Lieshout EMM, Van der Elst M (2013) The timing of ankle fracture surgery and the effect on infectious complications; a case series and systematic review of the literature. Int Orthop 37:489–494. https://doi.org/10.1007/s00264-012-1753-9

    Article  PubMed  PubMed Central  Google Scholar 

  5. White TO, Bugler KE, Appleton P et al (2016) A prospective randomised controlled trial of the fibular nail versus standard open reduction and internal fixation for fixation of ankle fractures in elderly patients. Bone Joint J 98-B:1248–1252. https://doi.org/10.1302/0301-620X.98B9.35837

    Article  CAS  PubMed  Google Scholar 

  6. Smith G, Mackenzie SP, Wallace RJ et al (2017) Biomechanical comparison of intramedullary fibular nail versus plate and screw fixation. Foot Ankle Int 38:1394–1399. https://doi.org/10.1177/1071100717731757

    Article  PubMed  Google Scholar 

  7. Department of Health (2006) South African good clinical practice guidelines. 1–72

  8. Burwell HN, Charnley AD (1965) The treatment of displaced fractures at the ankle by rigid internal fixation and early joint movement. J Bone Joint Surg Br 47-B:634–660

    Article  Google Scholar 

  9. Bugler K, Watson C, Hardie A et al (2012) The treatment of unstable fractures of the ankle using the Acumed fibular nail. J Bone Joint Surg Br 94-B:1107–1112. https://doi.org/10.1302/0301-620X.94B8.28620

    Article  Google Scholar 

  10. Laflamme M, Belzile EL, Bédard L et al (2015) A prospective randomized multicenter trial comparing clinical outcomes of patients treated surgically with a static or dynamic implant for acute ankle syndesmosis rupture. J Orthop Trauma 29:216–223. https://doi.org/10.1097/BOT.0000000000000245

    Article  PubMed  Google Scholar 

  11. Cherney SM, Cosgrove CT, Spraggs-Hughes AG et al (2018) Functional outcomes of syndesmotic injuries based on objective reduction accuracy at a minimum 1-year follow-up. J Orthop Trauma 32:43–51. https://doi.org/10.1097/BOT.0000000000001000

    Article  PubMed  Google Scholar 

  12. Asloum Y, Bedin B, Roger T et al (2014) Internal fixation of the fibula in ankle fractures. A prospective, randomized and comparative study: plating versus nailing. Orthop Traumatol Surg Res 100:S255–S259. https://doi.org/10.1016/j.otsr.2014.03.005

    Article  CAS  PubMed  Google Scholar 

  13. Switaj PJ, Fuchs D, Alshouli M et al (2016) A biomechanical comparison study of a modern fibular nail and distal fibular locking plate in AO/OTA 44C2 ankle fractures. J Orthop Surg Res 11:1–10. https://doi.org/10.1186/s13018-016-0435-5

    Article  Google Scholar 

  14. Smeets B, Hoekstra H (2016) Fibular nailing seems an effective strategy to decrease treatment crude costs for AO-type 44B ankle fractures in elderly patients. J Foot Ankle Surg 55:684–685. https://doi.org/10.1053/j.jfas.2016.03.014

    Article  PubMed  Google Scholar 

  15. Wigder H, Johnson C, Shah M et al (2003) Length of stay predicts patient and family satisfaction with trauma center services. Am J Emerg Med 21:606–607. https://doi.org/10.1016/j.ajem.2003.08.019

    Article  PubMed  Google Scholar 

  16. Jansen H, Jordan M, Frey S et al (2018) Active controlled motion in early rehabilitation improves outcome after ankle fractures: a randomized controlled trial. Clin Rehabil 32:312–318. https://doi.org/10.1177/0269215517724192

    Article  PubMed  Google Scholar 

  17. Ahl T, Dalén N, Lundberg A, Bylund C (1993) Early mobilization of operated on ankle fractures: prospective, controlled study of 40 bimalleolar cases. Acta Orthop 64:95–99. https://doi.org/10.3109/17453679308994541

    Article  CAS  Google Scholar 

  18. Wall BF, Kendall GM, Edwards AA et al (2006) What are the risks from medical X-rays and other low dose radiation? Br J Radiol 79:285–294. https://doi.org/10.1259/bjr/55733882

    Article  CAS  PubMed  Google Scholar 

  19. Brown OL, Dirschl DR, Obremskey WT (2001) Incidence of hardware-related pain and its effect on functional outcomes after open reduction and internal fixation of ankle fractures. J Orthop Trauma 15:271–274

    Article  CAS  Google Scholar 

  20. Badenhorst DHS, Chb MB, Sa FCO et al (2018) Lost to follow-up : challenges to conducting orthopaedic research in South Africa. South African Med J 108:917–921. https://doi.org/10.7196/SAMJ.2018.v108i11.13252

    Article  CAS  Google Scholar 

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Acknowledgements

The authors would like to thank all hospital staff that assisted during the course of this study.

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Authors and Affiliations

  1. Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, P.O. Box 19063, Tygerberg, Stellenbosch, 7505, South Africa

    DHS Badenhorst, IPS Terblanche, N Ferreria & MC Burger

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  1. DHS Badenhorst
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  2. IPS Terblanche
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  3. N Ferreria
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  4. MC Burger
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Correspondence to MC Burger.

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Badenhorst, D., Terblanche, I., Ferreria, N. et al. Intramedullary fixation versus anatomically contoured plating of unstable ankle fractures: a randomized control trial. International Orthopaedics (SICOT) 44, 561–568 (2020). https://doi.org/10.1007/s00264-020-04482-4

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  • DOI: https://doi.org/10.1007/s00264-020-04482-4

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