OTA 2005 Posters

Scientific Poster #3 Geriatrics and Reconstruction

The Fibula Nail for the Treatment of Ankle Fractures in the Elderly

Paul Appleton, MD (n); Margaret McQueen, MD, FRCS (n);

Charles Court-Brown, MD, FRCS (n);

Royal Infirmary of Edinburgh, Edinburgh, Scotland, United Kingdom

Purpose: Ankle fractures in the elderly have proven difficult to treat, with associated high complication rates (over 25% in some studies). Several different techniques are available for the treatment of displaced ankle fractures, including lag screws and plates, rush rods, and K-wires. Each method has its own associated complication,s including wound infections, implant failure, and prominent hardware that may require removal. Fibula nails have recently been developed that can theoretically provide stable fixation while minimizing the required exposure. The purpose of this study was to determine if stabilization of ankle fractures in the elderly using a fibula nail would provide adequate fixation and decrease complication rates.

Methods: A prospective study was undertaken in which displaced ankle fractures in the elderly were stabilized using a fibula nail. Between November 2003 and March 2004, 36 patients (average age 65 years) were enrolled in the study. Patients were followed for 12 months after their operation and evaluated with radiographs at each visit. Functional outcome was measured using the Olerud and Molander ankle score. Range of motion compared to the unaffected side was also measured.

Results: At 1 year postoperative, the average Olerud and Molander ankle score was 89/100. Range of motion had returned to within 5° of the unaffected ankle in all patients (excluding one patient who underwent an ankle fusion due to loss of fixation). There were two lateral wound infections, but after a course of antibiotics the metalwork was retained and the ankles went on to heal uneventfully. Three patients developed medial wound infections and eventually required removal of the metalwork. Two patients had a loss of fixation; one went on to a fusion while the other had minimal symptoms despite significant radiographic evidence of arthritis. At 1 year postoperative, 29 patients had normal radiographic measurements.

Conclusion/Significance: Although there were complications using the fibula nail for stabilizing ankle fractures, functional outcome was high. Our complication rate is lower than previously reported in other studies in this difficult to treat population. We feel that a fibula nail provides adequate fixation for ankle fractures in the elderly and should be considered to be a viable treatment option.