A prospective randomised controlled trial of the fibular nail versus standard open reduction and internal fixation for fixation of ankle fractures in elderly patients
2016
Aims The fundamental concept of open reduction and internal fixation
(ORIF) of ankle fractures has not changed appreciably since the
1960s and, whilst widely used, is associated with complications
including wound dehiscence and infection, prominent hardware and
failure. Closed reduction and intramedullary fixation (CRIF) using
a fibular nail, wires or screws is biomechanically stronger, requires
minimal incisions, and has low-profile hardware. We hypothesised
that fibular nailing in the elderly would have similar functional
outcomes to standard fixation, with a reduced rate of wound and
hardware problems. Patients and Methods A total of 100 patients (25 men, 75 women) over the age of 65
years with unstable ankle fractures were randomised to undergo standard
ORIF or fibular nailing (11 men and 39 women in the ORIF group,
14 men and 36 women in the fibular nail group). The mean age was
74 years (65 to 93) and all patients had at least one medical comorbidity. Complications,
patient related outcome measures and cost-effectiveness were assessed
over 12 months. Results Significantly fewer wound infections occurred in the fibular
nail group (p = 0.002). At one year, there was no evidence of difference
in mean functional scores (Olerud and Molander Scores 63; 30 to
85, versus 61; 10 to 35, p = 0.61) or scar satisfaction.
The overall cost of treatment in the fibular nail group was £91
less than in the ORIF group despite the higher initial cost of the
implant. Conclusion We conclude that the fibular nail allows accurate reduction and
secure fixation of ankle fractures, with a significantly lower rate
of soft-tissue complications, and is more cost-effective than ORIF. Cite this article: Bone Joint J 2016;98-B:1248–52.
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