title: A new technique for complex fibula fracture fixation in the elderly: a clinical and biomechanical evaluation.
abstract: OBJECTIVE
  To determine whether intramedullary fixation could augment plate fixation strength in comminuted and osteopenic fibula fractures.
  
  
  METHODS
  Retrospective clinical study and biomechanical laboratory study.
  
  
  METHODS
  Twenty comminuted or osteopenic fibula fractures in twenty patients age fifty years or older were stabilized using plate fixation augmented with intramedullary Kirschner wires. Nineteen patients were available for follow-up which averaged 15.4 months (range, 6-43 months). In conjunction with this clinical series, a biomechanical evaluation was performed comparing fixation of mildly osteopenic fibulas using this technique to plate and screws alone. The fibulas were first tested non destructively in bending, and then destructively in torsion to determine stability and ultimate strength of the fixation.
  
  
  RESULTS
  All nineteen fractures united without loss of reduction: seventeen of nineteen patients (89%) had either no pain, slight or mild pain. Biomechanical testing demonstrated that the resistance to bending of the plated fibulas augmented with Kirschner wires was 81% greater than the fibulas stabilized with a plate alone (p < .05). In torsional testing, the augmented group had twice the resistance to motion than the plate group (p < .002).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Joint Diseases Orthopaedic Institute, New York, New York 10003, USA.
authors.forename: K J
authors.initials: KJ
authors.lastname: Koval
authors.forename: D M
authors.initials: DM
authors.lastname: Petraco
authors.forename: F J
authors.initials: FJ
authors.lastname: Kummer
authors.forename: S
authors.initials: S
authors.lastname: Bharam
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology; D000843:Ankle Joint / Q000502:physiology; D001696:Biomechanical Phenomena; D001860:Bone Plates; D005260:Female; D005360:Fibula / Q000293:injuries*; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary / Q000379:methods*; D017102:Fracture Healing / Q000502:physiology*; D018460:Fractures, Comminuted / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D016896:Treatment Outcome; D016474:Weight-Bearing / Q000502:physiology