Determining the rotational strength of Lateral Malleolus Locking Plate versus Fibula Intramedullary nail in Supination External Rotation type IV injuries: cadaveric study
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Date
2018-10
Authors
Van Staden, Gideon Francois
Journal Title
Journal ISSN
Volume Title
Publisher
University of the Free State
Abstract
Introduction: Open reduction and internal fixation (ORIF) with anatomical reduction of
displaced ankle fractures have been the standard of care since the 1960, but are associated
with increased risk of complication, especially wound dehiscence and infections. Studies
showed that minimal invasive ankle fracture fixation with a fibula intramedullary nail can reduce
these complications with good clinical results after fracture fixation. Biomechanical evidence of
its strength compared with locking plates and screws, is currently limited.
Aims: We examined the biomechanical properties of a distal fibular locking plate with the fibula
intramedullary nail for fixation of ankle fractures induced in cadaveric models. Methods: 14
cadavers (28 limbs) were used and supination external rotation (SER) IV injury was surgically
created. Right limbs was allocated to the locking plate group and left limbs to the intramedullary
fibula nail group. Biomechanical testing was performed simulating an external rotation force.
Results: There was no statistical difference between the mean force needed for loss of
anatomical reduction in the locking plate group and fibula nail group. There was, however, a
statistical difference between the mean forces for total implant failure between the locking plate
group and fibula nail group.
Conclusion: This cadaver study supports previous biomechanical research findings of
comparable stability between the two surgical techniques when looking at the force needed to
cause loss of anatomical reduction. The locking plates, was however superior to the fibula nail with regards to the amount of force needed to cause implant failure. From a biomechanical
perspective, this showed that the fibula nail is be a viable option when treating unstable fibula
fractures.
Description
Keywords
Ankle fracture, Biomechanical stability, Lateral malleolus, Fibular nail, Intramedullary nail, Locking plate, Supination external rotation IV injury, Cadaver study, Dissertation (M.Med. (Orthopedic Surgery))--Univesity of the Free State, 2018