Intramedullary Nail Fixation of the Fibula as a Treatment Alternative of Ankle Fractures in a High Risk Patient Population

Transcription

1 Intramedullary Nail Fixation of the Fibula as a Treatment Alternative of Ankle Fractures in a High Risk Patient Population M. Christian Moody, MD Brian Weatherby, MD Greenville Health System Steadman-Hawkins Clinic of the Carolinas Greenville, SC

2 Disclosure No Conflict to Disclose Intramedullary Nail Fixation of the Fibula as a Treatment Alternative of Ankle Fractures in a High Risk Patient Population M. Christian Moody, MD Brian Weatherby, MD Our disclosures are in the Final AOFAS Mobile App. We have no potential conflicts with this presentation.

3 Purpose To identify high risk patients with multiple comorbidities who underwent fixation of unstable ankle fractures using an intramedullary fibular nail implant and present the clinical outcomes, complications, and Olerud and Molander scores.

4 Methods Retrospective review - High risk patients with fibular IMN - January 2011 and June 2015 All surgeries were at the same institution by the senior author Attempts were made to contact all patients Olerud and Molander Score Satisfaction questionnaire

5 High Risk Uncontrolled Diabetes Neuropathy Peripheral Vascular Disease Alcoholic abuse Drug abuse Drugs impairing wound healing (steroids, biologics, chemo) Non-compliant patients (mental illness, incarceration) Poor skin quality Excessive soft tissue edema

6 Results 22 high risk patients with 23 ankle fractures were included Average age (range) 64.3 years (41-82) Male / Female 11/11 Average tourniquet time (range) 35.6 minutes (0-72) Average operative time (range) 49.5 minutes (25-70) Average time until WBAT (range) 6.0 weeks (0-30) Average follow-up (range) 5.7 months (2-30) Fracture Pattern 18 bimalleolar/ 5 trimalleolar

7 Results All fractures went on to heal with radiographic evidence of bony union 4 patients non-compliant Began weight bearing immediately postoperatively 1 patient with a severe medial fracture blister pre-dating surgery required skin grafting and had delayed weightbearing due to skin healing (30 weeks)

8 Complications No surgical site infections, wound complications or non unions 2 patients required return to the OR for symptomatic screw removal 1 syndesmotic screw backed out, 1 distal AP screw Both patients non-compliant with weight bearing restrictions All nails were retained at last follow-up

9 Questionnaire 14 of the 22 patients were reached for participation Average time from follow up to questionnaire: 24.8 months (8-35) Average Olerud and Molander score: 77.9 (40-100) Satisfaction survey 64% very satisfied 29% satisfied 7% somewhat satisfied

10 Conclusion The intramedullary fibular nail construct is viable alternative method of fixation that allows for protection of soft tissue, stable fracture fixation and satisfactory outcomes in the high risk patient population. Further Level 1 research is needed to determine the long term outcomes of intramedullary fibular nails compared to plate and screw fixation.

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