A NEW TECHNIQUE FOR COMPLEX FIBULA FRACTURE FIXATION IN THE ELDERLY -A CLINICAL AND BIOMECHANICAL EVALUATION

Objective: To determine whether intramedullary fixation could augment plate fixation strength in comminuted and osteopenic fibula fractures. Study Design: Retrospective clinical study and biomechanical laborato ry study.Methods:Twenty comminuted or osteopenic fibula fractures in t wenty patients age fifty years or older were stabilized using plate fi xation augmented with intramedullary Kirschner wires. Nineteen patient s were available for follow-up which averaged 15.4 months (range, 6-43 months). Ln conjunction with this clinical series, a biomechanical ev aluation was performed comparing fixation of mildly osteopenic fibulas using this technique to plate and screws alone. The fibulas were firs t tested non destructively in bending, and then destructively in torsi on to determine stability and ultimate strength of the fixation. Resul ts: All nineteen fractures united without loss of reduction: seventeen of nineteen patients (89%) had either no pain, slight or mild pain. B iomechanical testing demonstrated that the resistance to bending of th e plated fibulas augmented with Kirschner wires was 81% greater than t he fibulas stabilized with a plate alone (p <.05). In torsional testin g, the augmented group had twice the resistance to motion than the pla te group (p <.002). Conclusion: This clinical series and biomechanical study support the use of plate fixation augmented with intramedullary Kirschner wires for the treatment of comminuted and osteopenic fibula fractures in the elderly.