BackgroundAnkle fractures are extremely common and represent nearly one quarter of all lower-limb fractures. In the majority of patients, fractures involve the distal fibula. The current standard in treating unstable fractures is through open reduction and internal fixation (ORIF) with plates and screws. Due to concerns with potentially devastating wound complications, minimally invasive strategies such as intramedullary fixation have been introduced. This systematic review was performed to evaluate the clinical and functional outcomes of intramedullary fixation of distal fibular fractures using either compression screws or nails.Materials and methodsNumerous databases (MEDLINE, PubMed, Embase, Google Scholar) were searched, 17 studies consisting of 1,008 patients with distal fibular fractures treated with intramedullary fixation were found.ResultsMean rate of union was 98.5 %, with functional outcome reported as being good or excellent in up to 91.3 % of patients. Regarding unlocked intramedullary nailing, the mean rate of union was 100 %, with up to 92 % of patients reporting good or excellent functional outcomes. Considering locked intramedullary nailing, the mean rate of union was 98 %, with the majority of patients reporting good or excellent functional outcomes. The mean complication rate across studies was 10.3 %, with issues such as implant-related problems requiring metalwork removal, fibular shortening and metalwork failure predominating.ConclusionOverall, intramedullary fixation of unstable distal fibular fractures can give excellent results that are comparable with modern plating techniques. However, as yet, there is unconvincing evidence that it is superior to standard techniques with regards to clinical and functional outcome.Level of evidenceLevel IV evidence.

We report on a 17-year-old man who underwent open reduction and internal fixation for an inferior dislocation of the right hip and displaced fractures of the right femoral head and neck, and antegrade intramedullary nailing for a displaced fracture of the left femoral shaft. In addition, 13 men and 4 women aged 5 to 56 (mean, 23) years with 16 unilateral and one bilateral inferior dislocation of the hip were reviewed from the literature.

Purpose. To measure the angular relationship between the Neviaser portal and the superior glenoid labrum in 60 cadaveric specimens to determine whether this portal can be used for reliable anchor placement. Methods. The Neviaser portal of 30 left and 30 right unpaired dry cadaveric scapulae with clavicles were measured by a single observer using an analogue vernier caliper. The angular relationship between the Neviaser portal and the 12 o'clock position of the glenoid labrum was calculated. Results. 13 of the 60 scapulae were excluded from analysis, because the Neviaser portal was medial to the glenoid rim making safe anchor insertion unfeasible. For the remaining 47 scapulae, the mean angles α and β were 58.2º and 57.9º, respectively. Compared with the ideal angles α and β of 30º and 0º, respectively, all the 47 Neviaser portals were more posterior (relative to the 12 o'clock position) and closer to the transverse plane, making insertion of suture anchors in the optimum position unfeasible, except for one that was within 10º of the ideal angles in both planes. Conclusion. Reliable insertion of suture anchors at the 12 o'clock position of the glenoid labrum through the Neviaser portal is unfeasible in most patients.

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