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.
T. O. White: Study design, Writing the paper, Data analysis.
K. E. Bugler: Data collection, Data analysis, Writing the paper.
E. Will†: Data collection, Writing the paper.
M. M. McQueen: Study design, Writing the paper.
C. M. Court-Brown: Study design, Writing the paper.
The authors would like to thank Mr A. Duckworth and Mr N. Clement for their help and advice with this paper and the statistical analysis.
The authors would like to declare that unrelated to this work, Acumed were sponsors of the Edinburgh International Trauma Symposium between 2009 and 2013 and that, although having no financial interest in the sales of the device, T. O. White was funded by the same to advise on design changes to the fibular nail in 2013.
The author or one or more of the authors have received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this article. In addition, benefits have been or will be directed to a research fund, foundation, educational institution, or other nonprofit organisation with which one or more of the authors are associated.
This article was primary edited by P. Page and first proof edited by G. Scott.
- Received January 19, 2015.
- Accepted April 27, 2016.
- ©2016 The British Editorial Society of Bone & Joint Surgery