Publication Excerpt

“The accurate reduction and fixation of the avulsed fragment is important for restoration of the stable distal tibiofibular joint and to prevent the chronic ankle joint pain caused by impingement of the avulsed fragment.”

Journal Abstract

Reference

Park JW, et al. Anterior tibiofibular ligament avulsion fracture in weber type B lateral malleolar fracture. J Trauma Acute Care Surg. 2002;52(4):655-9.

Publication Excerpt

“The fibula nail provides an alternative to standard plate fixation that uses a minimal approach and, therefore, decreases the incidence of wound infection and the need for further surgery to remove prominent metalwork while providing stable fixation.”

Journal Abstract

Ankle fractures in the elderly are increasing in incidence, and comorbidities, including diabetes, steroid use, and osteoporosis, can make these injuries difficult to treat in this population. Prominent metal work, infection, and wound problems are common complications. The fibula nail provides an alternative to standard plate fixation that uses a minimal approach and, therefore, decreases the incidence of wound infection and the need for further surgery to remove prominent metalwork while providing stable fixation.

Reference

Publication Excerpt

“This systematic review and meta-analysis shows that in a patient population of relatively high age, IMF (intermedullary fixation) of distal fibular fractures results in fewer wound-related complications, implant removals, and nonunions. In addition, subdivision of wound-related complications showed fewer wound healing disorders and superficial wound infections.” (compared to plate fixation)

Journal Abstract

Intramedullary fixation (IMF) has been described as a minimally invasive alternative to open reduction and internal fixation for operative treatment of distal fibular fractures in case of compromised soft tissue or severe comorbidities. The objective was to compare postoperative complications and functional outcomes of intramedullary versus plate fixation (PF) in distal fibular fractures. A systematic review and meta-analysis was performed. The PubMed/MEDLINE, Embase, Cochrane, and CINAHL databases were searched for both randomized controlled trials and observational studies. A total of 26 studies was included, reporting on 1710 patients with a mean age of 51.6 years. Meta-analysis was performed on 8 comparative studies, including subgroup and sensitivity analyses on all outcomes. IMF was associated with significantly fewer wound related complications (odds ratio [OR], 0.11; 95% confidence interval [CI], 0.04 to 0.25; p < .01), implant removals (OR, 0.54; 95% CI, 0.31 to 0.93; p = .03), and nonunions (OR, 0.31; 95% CI, 0.15 to 0.62; p < .01). No differences were found regarding malunion (OR, 0.45; 95% CI, 0.17 to 1.21; p = .11) and the Olerud Molander Ankle Score for long-term functional outcome (mean difference, 9.56; 95% CI, 1.24 to 20.37; p = .08). Results of this study apply to a select group of patients, in which the advantages of minimal soft tissue damage by IMF are preferable to optimal fracture reduction by PF. IMF of distal fibular fractures resulted in fewer wound-related complications, implant removals, and nonunions compared with PF. Especially in elderly patients, patients with chronic comorbidity, and patients with compromised soft tissue, IMF may be preferred over PF.

Reference

Tas D, Smeeing D, Emmink B, Govaert G, Hietbrink F, Leenen L, et al. Intramedullary fixation versus plate fixation of distal fibular fractures: a systematic review and meta-analysis of randomized controlled trials and observational studies. J Foot Ankle Surg. 2019;58:119−126.

Publication Excerpt

“Lateral fixation of AO type-B2 ankle fractures by the APCS (Acutrak Plus compression screw) is a safe and effective technique. It offers several advantages including stable fixation, a small surgical wound, less dissection of soft tissue, a headless device without palpable hardware, and easy applications with a short operating time.”

Journal Abstract

The Acutrak plus compression screw (APCS) (Acumed Inc., Beaverton, OR, USA) is an intramedullary implant which can achieve stable fixation with minimum soft tissue dissection. The characteristics of the APCS include fully-threaded length, headless, cannulated, and variable thread pitch. Twenty-three patients with AO type- B2 ankle fractures treated with lateral fixation by an APCS were retrospectively reviewed. Evaluation of postoperative roentgenograms for adequacy of reduction revealed a good reduction in 22 of 23 (95.7%) patients. The average wound incision was 4.1 cm. The operative time was 25.3 minutes. All the ankle fractures showed radiographic evidence of healing within four months. At the final follow-up, the ankle scores of the patients were evaluated for functional outcomes. Good to excellent results were obtained in 21 (91.3%) patients. No patient complained of symptomatic hardware. In conclusion, lateral fixation of AO type-B2 ankle fractures by APCS offers several advantages including stable fixation, a small surgical wound, less dissection of soft tissue, no palpable hardware, and easy application with a short operating time.

Reference

Chen SH, Huang CR, Hsu TL, Lee YS. Lateral fixation of AO type-B2 ankle fractures: the Acutrak Plus compression screw technique. Int Orthop. 2010;34(6):903-907.