Internal fixation with elastic intramedullary nail versus plate-screw system for treatment of fibular diaphyseal fracture / 中华创伤骨科杂志

ABSTRACT

Objective To compare elastic intramedullary nail (EIN) and plate-screw (P+S) system in the treatment of fibular diaphyseal fractures. Methods From January 2014 to April 2017, 48 tibiofibular fractures were treated with internal fixation using EIN (21 cases) or plate-screw (27 cases). The 2 groups were compared in terms of intraoperative blood loss, operative time, fibular healing time, fibular union rate, ankle function and postoperative complications.Results All the patients were followed up for 3 to 24 months (average, 14.0 months). The intraoperative blood loss (17.9 ± 4.9 mL), operative time (23.2 ± 5.8 min) and fibular healing time(10.3 ± 1.8 weeks)for the EIN group were significantly less than those for the plate-screw group (28.9 ± 9.6 mL, 30.0 ± 10.7 min and 11.6 ± 2.0 weeks)(P <0.05). There were no significant differences be-tween the 2 groups in fibular union rate(95.2% versus 92.6%) or incision infection(0 versus 7.4%)(P> 0.05) . The AOFAS ankle-hindfoot scoring revealed 12 excellent, 8 good and one fair cases (91.0 ± 5.3 points on aver-age) in the EIN group, and 14 excellent, 10 good and 3 fair cases(90.1 ± 6.1 points on average) in the plate-screw group, showing no significant difference between the 2 groups(P=0.594). Conclusions Compared with plate-screw system, elastic intramedullary nail for fibular diaphyseal fractures may be in line with the biome-chanical characteristics of the fibula and with the basic principles of minimally invasive surgery. It may be ad-vantageous in blood loss, operative time and fracture healing but not in fibular union rate or functional recovery of the ankle. An appropriate way of internal fixation for a fibular diaphyseal fracture should be chosen according to the specific conditions of the patient.