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Nailing the fibula: alternative or standard treatment for lateral malleolar fracture fixation? A broken paradigm

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

Despite the fact that open reduction and internal fixation with a plate, either non-locked or locked, is the standard of care for managing lateral malleolus fractures, intramedullary (IM) fixation of the fibula has been recently introduced as an alternative, mainly for some potential complicated situations. We hypothesized that almost all patterns of distal fibula fracture can be safely fixed with an IM device, with the potential benefit of providing biomechanical efficiency, but using a soft-tissue friendly implant. Here, we present a multicenter case series based on a proposed algorithm.

Patients and methods

Sixty-nine consecutive patients were managed with fibular IM fixation for closed malleolar fractures. Twenty patients were managed by IM screw fixation and 49 by fibular nailing. Outcome was measured both according to the American Orthopaedic Foot and Ankle Society (AOFAS) score for ankle and hindfoot, and the time to bone union.

Results

The mean AOFAS for Group I was 99.35 ± 1.95 points and that for Group II was 89.30 ± 16.98 points. There were no significant differences between the fracture pattern, according to the Lauge-Hansen classification, and post-operative levels of pain and functional activity among patients in both groups (p > 0.05). All fractures healed uneventfully in both groups. The mean time to union for Group I was 8.15 weeks and for Group II was 8.25 weeks (p > 0.05).

Conclusion

In this multicenter case series, intramedullary fixation for the lateral malleolus fracture presented itself as a viable and safe option for the treatment of almost all patterns of fibula fracture in adults. Overall, we were able to demonstrate the potential indications of the proposed algorithm for the choice of IM implant for the lateral malleolus fracture in terms of the Lauge-Hansen staged classification.

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Author information

Authors and Affiliations

  1. Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rua Mário Ribeiro 117/2º andar, Leblon, Rio de Janeiro, RJ, 22430-160, Brazil

    Vincenzo Giordano

  2. Clínica São Vicente, Rede D’or São Luiz, Rio de Janeiro, RJ, Brazil

    Vincenzo Giordano

  3. Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina (EPM), Sao Paulo, SP, Brazil

    Guilherme Boni

  4. Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo (USP), Sao Paulo, SP, Brazil

    Alexandre Leme Godoy-Santos

  5. Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil

    Alexandre Leme Godoy-Santos

  6. Departamento de Ortopedia, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil

    Robinson Esteves Pires

  7. Serviço de Ortopedia e Traumatologia, Hospital Geral Vila Penteado, Sao Paulo, SP, Brazil

    Junji Miller Fukuyama

  8. Departamento de Radiologia, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil

    Hilton A. Koch

  9. Academic Department of Trauma and Orthopaedic Surgery, School of Medicine, University of Leeds, Leeds, UK

    Peter V. Giannoudis

Authors
  1. Vincenzo Giordano
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  2. Guilherme Boni
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  3. Alexandre Leme Godoy-Santos
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  4. Robinson Esteves Pires
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  5. Junji Miller Fukuyama
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  6. Hilton A. Koch
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  7. Peter V. Giannoudis
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Corresponding author

Correspondence to Vincenzo Giordano.

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The authors declare that they have no conflict of interest.

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Giordano, V., Boni, G., Godoy-Santos, A.L. et al. Nailing the fibula: alternative or standard treatment for lateral malleolar fracture fixation? A broken paradigm. Eur J Trauma Emerg Surg 47, 1911–1920 (2021). https://doi.org/10.1007/s00068-020-01337-w

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  • DOI: https://doi.org/10.1007/s00068-020-01337-w

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