are rush nails still a good choice for fibula fixation in ankle fractures? a retrospective study with five years follow up

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 (p<0.05); 83.1 group a versus 90.1 group b at the aofas (p<0.05); 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 (p<0.05)) 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%) (p<0.05). radiographic evaluation showed more cases of post-traumatic osteoarthritis in group a (35.1% group a versus 15.4% group b (p<0.05)) and worse results in regards to restoration of joint space symmetry (45.6% group a versus 73.1% group b (p<0.05)). 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.