Percutaneous fixation of posterior malleolar fractures in patients with unstable ankle fractures treated with a fibular intramedullary nail: a description of a technique and review of outcomes

Sarah J Wordie, Thomas H Carter, Deborah MacDonald, Andrew D Duckworth, Timothy O White

Research output: Contribution to journalArticlepeer-review

Abstract

OBJECTIVES: (1) To describe the percutaneous technique used to reduce and fix a posterior malleolar fracture with anteroposterior (AP) screws in patients managed with a fibular intramedullary nail, (2) describe the selection of patients to whom this technique can be applied, and (3) report the clinical and patient reported outcome of this intervention.

DESIGN: Retrospective review.

SETTING: Academic orthopaedic trauma center.

PATIENTS: Thirty-two consecutive patients with a mean age of 65 years (range, 39-90) over a thirteen-year period identified from a prospective database.

INTERVENTION: Unstable ankle fractures managed surgically with a fibular nail and percutaneous fixation of the posterior malleolar component.

MAIN OUTCOME MEASUREMENTS: The primary short-term outcome was complications related to posterior malleolar fracture fixation. The primary mid-term outcome was the Olerud-Molander Ankle Score (OMAS). Secondary outcomes included the Manchester-Oxford Foot Questionnaire (MOXFQ), EuroQol-5D (EQ-5D), health, pain and satisfaction.

RESULTS: Thirty of the 32 (94%) posterior malleolar fractures united uneventfully. Post-operative loss of talar reduction occurred in two patients (6.3%), which in one patient (3.1%) eventually required a hindfoot nail arthrodesis. There were no soft tissue complications related to the AP screws or the fibular nail fixation. At a mean follow-up of 3.7 years (range, 1-8) the median OMAS, MOXFQ, EQ-5D, health, pain and satisfaction scores were 80.0, 23.4, 0.85, 80.0, 85.0 and 87.5 respectively.

CONCLUSION: Percutaneous ankle fracture fixation with a fibular nail and posterior malleolar screws results in reliable fracture stabilisation, good patient outcomes and high treatment satisfaction.

LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Original languageEnglish
JournalJournal of orthopaedic trauma
Early online date31 Aug 2021
DOIs
Publication statusE-pub ahead of print - 31 Aug 2021

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