The Use of Modern Intramedullary Nailing in Distal Fibula Fracture Fixation

Abstract

Background. Lateral malleolus (LM) fixation is necessary for unstable ankle fractures. Traditional fixation relies on the use of plates through a lateral incision, wound healing can be an issue for such incisions. A novel intramedullary (IM) fixation device has been developed that can be placed through a minimal incision. The purpose of this study was to demonstrate the clinical efficacy of this device. Methods. A retrospective analysis was performed on patients who received IM fixation for isolated fibula, bimalleolar (BM), and trimalleolar (TM) fractures. Pertinent demographic information, operative factors, complications, and clinical outcomes were recorded. Results. Sixteen patients were included in the study with an average age of 59 years (range 35-86 years). Six patients presented with isolated LM fractures, four patients had a BM fracture with a syndesmotic injury, 2 patients sustained a LM fracture with an associated syndesmotic injury, 2 patients had a BM fracture, and 2 patients had a TM fracture with a syndesmotic injury. There was a 100% healing rate of the lateral malleolus without any cases of malunion or shortening. There were no cases of sural nerve or peroneal tendon injuries, nor any wound complications found. Conclusion. These findings demonstrate the safe and efficacious use of a novel intramedullary fixation device for fibula fractures with lower wound complications compared with published outcomes found with lateral fibular plating. The features of this device allow for reliable fixation of the fibula, maintaining length and minimizing wound issues. Levels of Evidence: Level IV: Case series

Advances in the Surgical Management of Ankle Fractures

“…Bugler et al 9 published a series of 105 patients with unstable ankle fractures treated between 2002 and 2010 with an alternative fibula rod (Acumed, Hillsboro, OR). In contrast to the series by Tracey et al, 61 the authors noted a 4.7% infection rate related to the distal fibula and failure of fibular fixation in 6.6% of patients. Seventy-six percent of their patients had major medical comorbidities, including ischemic heart disease (15%), diabetes (10.4%), chronic obstructive pulmonary disease or asthma (9.5%), and stroke (8.5%).…”

“…Tracey et al 61 retrospectively reviewed a series of 16 patients with bimalleolar and trimalleolar ankle fractures treated with fibula intramedullary nailing (FibuLock; Arthrex Inc, Naples, FL) for the lateral malleolus and reported a 100% union rate of the lateral malleolus with no wound infections despite 5 patients having diabetes and 1 being a smoker. Bugler et al 9 published a series of 105 patients with unstable ankle fractures treated between 2002 and 2010 with an alternative fibula rod (Acumed, Hillsboro, OR).…”

“…Tracey et al 61 retrospectively reviewed a series of 16 patients with bimalleolar and trimalleolar ankle fractures treated with fibula intramedullary nailing (FibuLock; approach was used to access both fragments that were fixed using two 2.4-mm buttress plates (E) followed by syndesmotic fixation using a 4-hole 1/3 tubular plate with 2 divergent TightRopes.…”

Trends of incidence and treatment strategies for operatively treated distal fibula fractures from 2005 to 2019: a nationwide register analysis

“…These include anatomical locking plates [12] and intramedullary nails [13] for distal fibular fractures. Locking plates and intramedullary nails were designed predominantly for the elderly population, as they were shown to enhance the biomechanical stability and reduce wound healing problems especially in patients at risk [14][15][16][17][18][19]. However, the authors are not aware of any study evaluating the actual implementation of these modern treatment strategies into daily practice.…”

Intramedullary Fixation of Distal Fibula Fractures

“…A smaller study consisting of only 16 patients was published on this IM device, reporting union rates of 100% for lateral malleolus fractures. 15…”