Description
In this insightful presentation, Tim White discusses the advantages and rationale behind the use of fibular nails in treating frail, elderly patients with ankle fractures. Starting with a clear disclaimer that he did not invent the fibular nail and that his role is purely as an enthusiastic proponent, he outlines three key reasons for the adoption of this surgical technique: reducing early soft tissue complications, avoiding issues related to prominent metalwork that may necessitate further surgery, and providing superior mechanical stability through intramedullary fixation.
White explains the minimally invasive nature of the surgery, emphasizing how it preserves the ankle joint and minimizes damage to surrounding tissues. He provides a brief overview of the procedure, including the setup, incision locations, and the careful use of fluoroscopy for accurate placement of the nail. Feedback from audience members indicates varying familiarity with this technique, prompting White to ensure clarity for those less experienced.
As he progresses, he shares data from his studies, highlighting the effectiveness and safety of fibular nailing in multiple patient demographics, including both elderly and younger populations at risk for specific soft tissue injuries. With statistical support and anecdotal success stories, he advocates for fibular nails over traditional open reduction internal fixation methods, underscoring the latter's higher associated soft tissue complication rates.
White's evidence-based assertions are punctuated by detailed comparisons of various treatment options, including advantages of the fibular nail over hindfoot nails and casting methods. His extensive experience is corroborated by recent meta-analyses, showing high union rates and excellent functional outcomes associated with fibular nailing.
He closes with a cautionary note against the emerging use of fibular nails in pelvic fractures without supporting evidence, reinforcing the importance of thorough clinical validation before expanding their application. The presentation concludes with audience applause, reflecting the valuable insights shared on this evolving surgical technique.