- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05204485
Diabetic Fibular Nail Study
Prospective, Randomized-Control Trial Comparing Intramedullary Fibular Fixation With Standard Open Reduction And Internal Fixation In Diabetic Patients With Unstable Ankle Fracture
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Our null hypothesis is that fibular intramedullary fixation (IMFN) does not impact complication rates when compared to standard of care treatment with open reduction and internal fixation (ORIF). There are no current or past RCTs comparing these fixation techniques to one another in diabetic patients. There is good data supporting both the use of intramedullary fixation for fibular fractures alone, and in high-risk patient populations (elderly, and diabetics). However, the effectiveness of these methods with respect to each other has never been investigated. The knowledge gained will allow us to potentially influence and adapt protocols to treat this patient population. Additionally, resources available at our institution provide a supportive framework with which to maintain contact with patients after hospital discharge. These key factors will allow us to perform a robust analysis of this population, to include outcomes measures of function and complications.
With much of the existing literature on fibular nails being retrospective with limited focus on the diabetic population, there is no clear guidance on when the use of this device is indicated. Retrospective studies in fracture patients bring in significant bias given that a specific surgical technique may be chosen because of individual patient factors including soft tissue condition, fracture pattern and perceived level of risk. This limits our understanding of how an implant will perform across the population of interest. Our approach to randomize our patients will reduce the bias that exists in the current literature. In addition, the only prospective study that has been performed on the fibular nail was in elderly patients in which only two patients were diabetic. Given the many challenges with high rates of infection in this patient population we seek intramedullary fibular fracture fixation as a treatment that could potentially change this existing paradigm
Primary Objective Compare post-operative all cause complications in diabetic patients with ankle fractures.
Secondary Objective(s) Compare patient reported outcomes, range of motion, pain and radiographic outcomes in patients treated with ORIF vs. fibular intramedullary nails.
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Kelly Hynes, MD
- Phone Number: 773-834-3531
- Email: khynes@bsd.uchicago.edu
Study Locations
-
-
Illinois
-
Chicago, Illinois, United States, 60637
- Recruiting
- University of Chicago
-
Contact:
- Justin Bell, BA
- Phone Number: 773-834-0822
- Email: jbell3@bsd.uchicago.edu
-
Principal Investigator:
- Kelly Hynes, MD
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Age 18 or older
- Unstable ankle fracture
Diagnosis of Diabetes:
- Fasting BG > 120
- Non-fasting BG > 200
- HbA1c > 6.5
Exclusion Criteria:
- Patients not meeting inclusion criteria (stable fracture patterns, non-diabetics)
- Poly-trauma patients (multiple [>2] extremity injuries that interfere and/or limit patient mobilization
- Open fractures
- Delayed presentation of fracture (>4 weeks)
- Fractures that the treating surgeon indicates requires a posterior approach to achieve stability
- Patients with an active infection or wound at the ankle
- Utilizing worker's compensation at the time of screening
- Any previous ligament or fracture surgery on the index ankle
- Inflammatory rheumatic disease or other rheumatic disease
- Immune compromised patients (hepatitis, HIV, etc.)
- Non-English speaking patients
- Unwilling or unable to follow study protocol
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Fibular intramedullary nail
Randomized in the OR to ankle fracture repair with fibular intramedullary nail
|
The standard manufacturers approved technique will be performed including the use of 2 distal interlocking screws and the use of a minimum of 1 fibula pro tibia fixation screw depending on the patients' anatomical characteristics.
|
Active Comparator: Open reduction and internal fixation (ORIF)
Randomized in the OR to ankle fracture repair with ORIF
|
An open approach (direct lateral or posterolateral incision) will be carried out.
The reduction will be performed using standard techniques of clamping and traction.
Fixation will be performed after reduction of the fracture with a plate and screw construct.
The surgeon will then proceed to perform surgical fixation of other associated fractures or ligament injuries as indicated.
This will most often include open reduction and internal fixation of the medial malleolus with screws through a separate medial incision.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Composite complication rate
Time Frame: 1 year post-operatively
|
The difference in overall composite complication rate between Fibular intramedullary fixation and ORIF
|
1 year post-operatively
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Patient reported outcome scores
Time Frame: 1 year post-operatively
|
Any difference in Patient reported outcomes scores (PROMIS Physical Function or Pain Interference CAT) score between Fibular Intramedullary fixation and ORIF
|
1 year post-operatively
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Kelly Hynes, MD, University of Chicago
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- IRB21-1218
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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