Introduction. The condition of the soft tissues surrounding an ankle fracture influences timing and treatment of injuries. Conventional treatment used an open approach to facilitate anatomical reduction and rigid internal fixation. Intramedullary devices for fibular fractures provide a safe alternative in patients in which the condition of the soft tissue envelope or the patient's co-morbidities may benefit from a less invasive approach. We compared outcomes for patients treated with open reduction internal fixation (ORIF) with those undergoing treatment with fibular nails (FN). Methods. 13 consecutive patients treated with fibular nails (FN) were compared with 13 age-matched patients that underwent open reduction and internal fixation (ORIF). All patients were followed to union. Study outcomes were time from admission to surgery, length of stay, wound failure, implant failure, revision surgery, OMAS and SF-36. Results. There was no difference in age or sex distribution between groups. There was no difference in OMAS at 1 year (83 ± 9 in FN group; 80± 21 in ORIF group) and SF-36 (94 ± 11 and 90 ± 20). There were 2 implant failures in the ORIF group and none in the FN group. There was one wound failure in the ORIF group and none in the FN group. Patients treated with FN had a shorter time to surgery (1 day ± 24 hours vs 3 days ± 24 hours) and shorter length of stay (1 day ± 24 hours vs 4 days ± 96 hours). Conclusion. FN is a safe method to treat patients with displaced distal fibular fractures that may have a poor soft tissue envelope and risk factors for wound healing. FN reduces the time to surgery and overall length of stay compared with similar patients treated with conventional ORIF

Introduction. The primary goal of treatment of an ankle fracture is to obtain a stable anatomic fixation to facilitate early mobilisation and good functional recovery. However, the need for open reduction and internal fixation must be weighed against poor bone quality, compromised soft tissues, patient co-morbidities and potential wound-healing complications. Materials and Methods. We reviewed two matched groups of 18 patients each, who underwent fixation for unstable Weber-B ankle fractures with intramedullary fibular nail (Group 1) and Standard AO semi-tubular plate osteo-synthesis technique (Group 2) to achieve fracture control and early mobilisation. Clinical and radiological fracture union time, and the time at mobilisation with full weight bearing on the ankle were used as outcome measures. Results. The mean age of patients in both the groups was 53.6 yrs and 55.5 yrs respectively. The mean follow-up period was 5.4 months (Group 1) and 6.9 months (Group 2) before discharge. Clinical and radiological union was achieved earlier in patients treated with intramedullary fibular nail (7.3 weeks & 8.7 weeks respectively) compared with plate osteo-synthesis treatment (8.2 weeks & 9.8 weeks respectively) and this was statistically insignificant (p=0.66 & p=0.54 respectively). Patients achieved full weight bearing at 8.4 weeks in nailing group compared to 8.2 weeks in plate osteo-synthesis group (p=0.40). One patient in the plate osteo-synthesis group had wound infection, requiring removal of hardware after fracture union. There were no wound complications in the nailing group. Conclusion. Open reduction and internal fixation with the use of plates and screws based on the AO osteo-synthesis technique remains gold standard for treatment of ankle fracture. Advantages of fibular nail include a minimally invasive procedure with respect to fracture biology, feasibility of its use in compromised soft tissue states and negligible wound healing complications and can be used as a viable alternative

Techniques for fixation of the lateral malleolus have remained essentially unchanged since the 1960s, but are associated with complication rates of up to 30%. The fibular nail is an alternative method of fixation requiring a minimal incision and tissue dissection, and has the potential to reduce complications. We reviewed the results of 105 patients with unstable fractures of the ankle that were fixed between 2002 and 2010 using the Acumed fibular nail. The mean age of the patients was 64.8 years (22 to 95), and 80 (76%) had significant systemic medical comorbidities. Various different configurations of locking screw were assessed over the study period as experience was gained with the device. Nailing without the use of locking screws gave satisfactory stability in only 66% of cases (4 of 6). Initial locking screw constructs rendered between 91% (10 of 11) and 96% (23 of 24) of ankles stable. Overall, seven patients had loss of fixation of the fracture and there were five post-operative wound infections related to the distal fibula. This lead to the development of the current technique with a screw across the syndesmosis in addition to a distal locking screw. In 21 patients treated with this technique there have been no significant complications and only one superficial wound infection. Good fracture reduction was achieved in all of these patients. The mean physical component Short-Form 12, Olerud and Molander score, and AAOS Foot and Ankle outcome scores at a mean of six years post-injury were 46 (28 to 61), 65 (35 to 100) and 83 (52 to 99), respectively. There have been no cases of fibular nonunion. Nailing of the fibula using our current technique gives good radiological and functional outcomes with minimal complications, and should be considered in the management of patients with an unstable ankle fracture

Introduction. Fixation of the distal fibula in conjunction with ankle fractures has not changed over the last 50 years. The complication rate of these fixation techniques is as high as 30%. The fibula nail is an alternative method of fixation and uses a minimal invasive technique. This technique preserves soft tissue compared to previous techniques used, and fewer soft tissue complications. Method. We reviewed the preliminary results of 178 patients with unstable Weber B and C ankle fractures that were operated on in our unit between January 2012 and February 2013. We used the Acumed fibular nail for reduction and fixation of the lateral malleolus. Using the nail we had significant reduction in our operating time. Patients were discharged one day post operation without any POP and partial weight bearing on crutches. Various parameters were measured on all the follow- up x-rays and assessed for incongruencies compared with the normal ankle. These parameters were medial clearspace, talo-crural angle, talar tilt and fibular length. No patients thus far have had any loss of fixation. The Olerud and Molander score was used at three month and six month follow up. Results. Patients at three months scored an average of 80 and at six months an average of 85. There were no cases of non-union. 40 patients had systemic co-morbidities. We had four superficial wound complications that healed well with antibiotics and daily wound care. Conclusion. The fibula nail is an effective fixation technique for most Weber B and C ankle fractures. It causes minimal destruction of the soft tissue. Functional outcome of patients is excellent. NO DISCLOSURES