Internal fixation of the fibula in ankle fractures: a prospective, randomized and comparative study: plating versus nailing.
AIM
Open reduction and internal plate fixation of the fibula is the gold standard treatment for ankle fractures. The aim of this study was to perform a prospective randomized study to compare bone union, complications and functional results of two types of internal fixation of the fibula (plating and the Epifisa FH intramedullary nail).


MATERIALS AND METHODS
Inclusion criteria were: closed fractures, isolated displaced fractures of the lateral malleolus, inter- and supra-tubercular bimalleolar fractures, and trimalleolar fractures. This study included 71 patients (mean age 53 ± 19): plate fixation group (n=35) and intramedullary nail fixation group (n=36). In seven cases, intramedullary nailing was technically impossible and was converted to plate fixation (the analysis of this sub-group was performed independently). Two patients died and two patients were lost to follow-up. The final comparative series included 32 cases of plate fixation and 28 cases of intramedullary nail fixation. Union, postoperative complications and Kitaoka and Olerud-Molander functional scores were analyzed after one year of follow-up.


RESULTS
There was no significant difference in the rate of union (P=0.5605) between the two types of fixation. There were significantly fewer complications (7% versus 56%) and better functional scores (96 versus 82 for the Kitaoka score; 97 versus 83 for the Olerud-Molander score) with intramedullary nailing than with plate fixation.


CONCLUSION
Intramedullary nailing of the lateral malleolus in non-comminuted ankle fractures without syndesmotic injury is a reproducible technique with very few complications that provides better functional results than plate fixation.


LEVEL OF EVIDENCE
II (randomized prospective study).
['Asloum|Y|Y|', 'Bedin|B|B|', 'Roger|T|T|', 'Charissoux|J-L|JL|', 'Arnaud|J-P|JP|', 'Mabit|C|C|']
D000293:Adolescent D000328:Adult D000368:Aged D000369:Aged, 80 and over D064386:Ankle Fractures D001858:Bone Nails D001860:Bone Plates D005260:Female D005360:Fibula D005500:Follow-Up Studies D005593:Fracture Fixation, Internal D005594:Fracture Fixation, Intramedullary D017759:Fractures, Malunited D006801:Humans D015994:Incidence D008297:Male D008875:Middle Aged D011183:Postoperative Complications D011446:Prospective Studies D011859:Radiography D016037:Single-Blind Method D016896:Treatment Outcome D055815:Young Adult
Internal fixation Ankle fracture Fibular nail Lateral malleolar fracture