SLR - June 2018 - Vlad Sauciuc

A Prospective Randomized Controlled Trial of the Fibular Nail Versus Standard Open Reduction and Internal Fixation for Fixation of Ankle Fractures in Elderly Patients

Reference: White TO, Bugler KE, Appleton P, Will E, McQueen MM, Court-Brown CM. 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. 2016 Sep; 98-B(9):1248–52.

Scientific Literature Review

Reviewed By: Vlad Sauciuc, DPM
Residency Program: Tucson Medical Center/Midwestern University Health Science Center, Tucson, AZ

Podiatric Relevance: Ankle fractures are commonly encountered in podiatric surgery. Complications of open reduction and internal fixation (ORIF) have been well documented and include infection and wound dehiscence, with higher rates of occurrence in the elderly population. Closed reduction with an intramedullary fibular nail (CRIF) can be considered in an attempt to reduce these complications. The authors aim to compare ORIF versus CRIF in elderly patients with unstable ankle fractures with a hypothesis the CRIF will have similar functional outcomes to ORIF with decreased complications.

Methods: The authors performed a prospective trial of 100 patients more than 65 years of age (mean age of 74) who presented with unstable ankle fracture and were randomized to receive either standard ORIF or CRIF. Complications, patient-related outcomes and cost effectiveness were studied over 12 months. The primary outcome measure was functional recovery as measured by the Olerud and Molander Ankle Score (OMS). Secondary outcomes include the incidence and nature of complications.

Results: Fifty patients underwent standard ORIF, and 50 patients underwent CRIF. In the fibular nail group, significantly fewer wound infections occurred (p = 0.002), with no infections reported in the fibular nail group and eight superficial wound infections in the ORIF group. At one year, no difference in the mean functional score (OMS) or scar satisfaction were noted. The cost of treatment in the fibular nail group was overall slightly less.

Conclusion: The authors compared ORIF to CRIF in elderly patients more than age 65 presenting with unstable ankle fracture. The study found a decrease in wound complications in patients undergoing CRIF with no significant difference in scar satisfaction or in mean functional scores. Therefore, based on the results, consideration can be given to perform CRIF in the elderly population in an attempt to decrease local soft-tissue-related complications.

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