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Department of Trauma and Orthopedics, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy.
Published: January 2023
AI Article Synopsis
Article Abstract
Objectives: The aim of this retrospective study is to evaluate if Rush nail fixation still has a role in distal fibular fractures surgery compared with locking plate in terms of fixation quality, complications, functional results and patient satisfaction level.
Methods: This study included 109 patients (average age 56.05), who had undergone operative treatment for bi- or trimalleolar fractures between 2009 and 2014. The patients were evaluated retrospectively, divided in group A (57 patients treated with Rush nail) and group B (52 patients treated with locking plate). The patients were evaluated at an average 4.9 years of follow-up (SD: 1.01) with Olerud-Molander Ankle Score (OMAS), American Orthopedic Foot and Ankle Society - Ankle-Hindfoot Scale (AOFAS) and Visual Analogue Scale (VAS) for clinical outcomes. X-rays were conducted to assess ankle osteoarthritis using the classification system by Takakura and joint space symmetry using measurements in comparison with contralateral ankles.
Results: The groups were homogeneous regarding age and gender. Patients treated with Rush Nail fixation (Group A) showed statistically significant worse clinical results at functional scores (78.1 Group A versus 88.7 Group B at the OMAS (); 83.1 Group A versus 90.1 Group B at the AOFAS (); higher pain levels in the VAS (3.9 Group A versus 2.4 Group B) and lower satisfaction rates (52.6% Group A versus 73.1% Group B ()) in comparison with patients treated with locking plate fixation (Group B). However, infections rate was significantly lower in Group A (1.8%) than in Group B (9.6%) (). Radiographic evaluation showed more cases of post-traumatic osteoarthritis in Group A (35.1% Group A versus 15.4% Group B ()) and worse results in regards to restoration of joint space symmetry (45.6% Group A versus 73.1% Group B ()).
Conclusion: Results of current study indicates that even though plating of lateral malleolus in bimalleolar and trimalleolar fractures is superior in fracture reduction quality, early functional recovery, reduced incidence of post-traumatic osteoarthritis and greater patient satisfaction, Rush nail fixation still provides acceptable clinical results with a lower infection rate. Therefore Rush nails could be considered as a valid choice in selected patients with high risk of soft tissue complications or low functional demand.
