Summary
Fibula-sided complications occurred due to technical factors such as tightrope malpositioning and failure to prevent fibula fracture shortening.
Abstract
Introduction
Ankle fractures are a common orthopaedic injury, with approximately a quarter of cases classified as unstable and necessitating surgical intervention. Traditionally, the plate-and-screw construct has been employed for fixing fibula fractures. However, an alternative method utilizing intramedullary nails is gaining traction, supported by literature citing minimally invasiveness of the procedure and reduced need for hardware removal. We report our learning experience and analysis of fibula-sided complications in the first 26 cases of the Fibulock nail at our institution.
Methods
26 consecutive fibula nails were retrospectively reviewed. Data on demographics, fracture classification and radiographic outcome were recorded. Fibula sided complications were determined as fixation failure, malpositioning of transyndesmotic fixation and fibula shortening >2 mm. Two senior foot and ankle surgeons analysed the cases to determine the cause for fibula sided complications.
Results
70% were female. 42% were above age of 60. Mechanism of injury was fall (65%), sports (19%) RTA (11%) and direct impact (4%). 11% had peripheral vascular disease, 23% diabetes mellitus and 4% end stage renal failure. 50% are AO B2/3, 19% C1, 38% C2 and 4% 4F2. Quality of reduction was good to excellent (80%), fair (10%) and poor (10%). Fibula-sided complications (19%) included tightrope malposition (n=1), fixation failure (n=2) and fibula shortening >2mm (n=2). Deep infection was 6%. Overall early revision rate was 23%. After the first 19 cases, there were no-fibula sided complications or deep infection.
Discussion
Understanding the nail design and its limitation is key to success. Fibula-sided complications occurred due to technical factors such as tightrope malpositioning and failure to prevent fracture shortening from the use of tightrope and poor interference fit of the proximal nail talons. Our learning curve showed that after the first 19 cases, there were no fibula sided complications.
Conclusion
Fibula-sided complications occurred due to technical factors such as tightrope malpositioning and failure to prevent fibula fracture shortening.