Fibula Nail versus Locking Plate Fixation-A Biomechanical Study

In the treatment of ankle fractures, complications such as wound healing problems following open reduction and internal fixation are a major problem. An innovative alternative to this procedure offers a more minimally invasive nail stabilization. The purpose of this biomechanical study was to clarify whether this method was biomechanically comparable to the established method. First, the stability (range of motion, diastasis) and rotational stiffness of the native upper ankle were evaluated in eight pairs of native geriatric specimens. Subsequently, an unstable ankle fracture was created and fixed with a locking plate or a nail in a pairwise manner. The ankles showed significantly less stability and rotational stiffness properties after nail and plate fixations than the corresponding native ankles (p < 0.001 for all parameters). When comparing the two methods, both showed no differences in their range of motion (p = 0.694) and diastasis (p = 0.166). The nail also presented significantly greater rotational stiffness compared to the plate (p = 0.001). However, both fixations remained behind the native stability and rotational stiffness. Due to the comparable biomechanical properties of the nail and plate fixations, an early weight-bearing following nail fixation should be assessed on a case-by-case basis considering the severity of fractures.

Automated summary

In the treatment of ankle fractures, complications related to wound healing after open reduction and internal fixation are a significant issue. A minimally invasive nail stabilization technique has been proposed as an alternative. This biomechanical study aimed to determine if this technique is comparable to the established method. The results showed that both the nail and plate fixations resulted in reduced stability and rotational stiffness compared to the intact ankle. While the nail fixation had greater rotational stiffness, both methods fell short of the native stability. The study suggests that weight-bearing after nail fixation should be evaluated on a case-by-case basis.