The Use of a Fibular Nail to Treat Ankle Fractures in Patients With Diabetes

Abstract

Category: Trauma Introduction/Purpose: Patients with diabetes have difficulty healing skin and bone after ankle fractures. A paper published previously demonstrated a much higher rate of wound complications and amputation in patients with diabetes compared to those without diabetes. The purpose of this study was to analyze the outcome of patients with diabetes and ankle fractures prospectively followed using a fibular nail. The primary outcome was bone healing as assessed by CT scan at 12 weeks, and secondary outcomes were outcome scores, reoperation rates, mortality and wound complications. Methods: 10 patients with diabetes and ankle fractures (Weber b and c, isolated fibula, bi-maleolar and tri-maleolar fractures) were treated with a fibular nail for the fibular fracture, and percutaneous screw fixation for the posterior or medial maleolar fractures. Patients included were those with diabetes with an HBA1c of over 7 or other systemic complications of diabetes. Patients had to survive for 12 weeks after the procedure for inclusion. Excluded were fractures outside the ankle, concomitant injuries, patients unable to follow the study protocol and those with open injuries. The CT scans were assessed on both the Sagittal and Coronal views for bone healing at the fracture site. Each slice was measured for the percent of bone bridging. Results: One patient was excluded because of mortality before the 12 week visit. A second patient survived the 12 week follow up and died before 24 weeks. Successful bone bridging was seen in all patients by 12 weeks. The bone bridging was estimated to be 70 +/- 16% (SD) on the sagittal view and 75 +/- 10% on the coronal view at 12 weeks and was on the 82% sagittal view and 80% on the coronal view at 24 weeks. No hardware failure was seen. No fracture failed to unite. There were no mal-unions or non-unions either clinically or radiographically. There was one proximal locking screw wound treated with debridement and antibiotics with successful outcome. This patient developed a charcot arthropathy and underwent ankle fusion. Conclusion: This prospective case series demonstrates that the fibular nail can generate successful bone healing and excellent alignment after ankle fractures in patients with diabetes. A further comparative study with plate fixation is merited.