Good morning everyone, I'm Natalia Petrakovich and I'm going to present you our research named does intramedullary nail for this fibular fracture restore anatomic parameters in terms of syndesmosis relationship. I've got no conflict of interest regarding this investigation and well as you know fibular nailing is a very novel method which have been proven to be useful especially in the treatment of distal fibular fractures in elderly patients. So if you're doing a percutaneous reduction, internal fixation, maybe the nail is the best option since you are going to minimize the soft tissue complications and it provides similar stability compared to plaiting for example but with less hardware related symptoms. So it seems to be the best choice for diabetics, elderly patients or patients with soft tissues envelope not that good for a big incision. But there are some controversies regarding if this device is able after you do your percutaneous reduction to maintain especially their rotation and the length of the fibula. So our study aimed to evaluate the fibular syndesmotic reduction after a fixation with the fibular nail and we compared it with the contralateral site, the non-injured ankle. So we did a prospective core, a cross-sectional study with a per control group. We basically studied all the patients that we did a percutaneous reduction and internal fixation with the fibular nail system of Acumet and we performed immediate post-operative bilateral CT scan in all cases and all the images were evaluated by two independent radiologists and we measure basically, they measure basically all the anatomic parameters. We perform a statistic analysis using the Wilcox-Tesla intraclass correlation coefficient and we consider a medium-sized sample effect using a 95 confidence with a 0.05 alpha error. So actually we measure the diastasis of the fibular syndesmotic, the length of the fibula and the translation and rotation. Well our results basically showed that there was no difference between rotation in the fibular fracture site and the contralateral site. There was no difference also in diastasis of the fibula in the syndesmosis. We were able to restore the length of the fibula but there was a slight malreduction of the fibula in terms of anterior translation or posterior translation in the syndesmosis in five cases. So in this series, three of four parameters were established almost to anatomic with the potential reduction and the use of the fibular nailing but there was one parameter which has a statistic difference with the normal contralateral ankle which was the translation of the fibular in the syndesmosis in five of the 26 patients, which is very similar to the basically malreduction rate of the literature using rigid fixation. We believe that at least in part this malreduction is influenced by the use of rigid fixation of the syndesmosis. So even though, as I told you before, the malreduction of the syndesmosis is very similar to other fixation systems of the syndesmosis in the distal fibular fracture, this malreduction may be avoided by controlling specifically the syndesmosis reduction, maybe using CT scans operatively, or maybe you can scope your syndesmosis to be sure that you are doing a very good reduction of it. So the strength of these studies is that it's basically the first prospective study using bilateral CT scan comparing the fracture site with the normal site, but it would be very good to have maybe a controlled group of fractures, these are fibular fractures, fixed with the plating, and also there may be a bias in the use of the fibular fracture cases, maybe in the simple cases. So for us, at least, the conclusion of this study is that the percutaneous reduction of the fibula in fibular fracture is a game changer procedure, and the fibular nail seems to be the perfect implant for that. The fibular nail after percutaneous reduction restores in an atomic way almost all the parameters except for anterior translation of the fibula in the syndesmosis, and maybe in the future we may use, for example, some kind of implant with more flexible syndesmosis fixation to avoid this malreduction, or we should do this CT intraoperatively, or maybe we should scope our fractures to be sure that our syndesmosis is perfectly reduced. Our patients have a similar malreduction compared with the literature, but as I told you before, I'm sure that we can improve our malreduction maybe by taking the screw of the percutaneous heel or considering a new generation of implants with more flexible syndesmosis fixation. Thank you very much.

fibular fracture

intramedullary nails

anatomic parameters

syndesmosis relationship

fibular syndesmotic reduction