Fibular Nail Fixation: Topical Review

Abstract

Background: Intramedullary implants have been used historically in long bone fractures with success. In recent years, a variety of intramedullary implants for the treatment of fibular fractures have been investigated. These various implants have not been assessed together in a cohesive manner. In this review, we assess implants used for intramedullary fixation of fibular fractures with respect to implant design and clinical results. Methods: A comprehensive systematic literature review for intramedullary implants in fibular fractures was performed. All publications that assessed intramedullary fibular implants were reviewed. In total, 11 different intramedullary nails were found. Clinical results obtained from these studies were reviewed. Results: The intramedullary implants used for fibular fracture fixation generally fell into one of 3 categories: an unlocked longitudinal strut, an implant roughly equivalent to a large screw, or a more traditionally locked intramedullary nail. Reported clinical results were generally good, although inconsistent outcome reporting greatly limited comparison between studies. Complication rates varied with the implants but were generally low. Conclusion: Intramedullary implants for fibular fracture stabilization have changed over the years to improve stability. Although clinical results are limited, data suggest that these implants are safe and can potentially approximate more traditional implants. Level of Evidence: Level II, systematic review.

Midterm Outcomes of Unstable Ankle Fractures in Young Patients Treated by Closed Reduction and Fixation With an Intramedullary Fibular Nail vs Open Reduction Internal Fixation Using a Lateral Locking Plate

“…In this study, Weber type C, pronation-type injury, and comminuted fracture of the fibula were found to be related to poor reduction at final follow-up in the IMN group, which is consistent with the results of previous studies. 4,5,18 This is thought to be caused by the failure of the IMN to provide sufficient stability for these types of injury as well as the initial poor reduction identified on 3D-reconstructed CT images. Bäcker and Vosseller 5 demonstrated that, in fibular fractures with proximal comminution, the IMN can piston or slide in the fibular shaft, eventually shortening the fibula due to its inherent limited axial stability.…”

“…4,5,18 This is thought to be caused by the failure of the IMN to provide sufficient stability for these types of injury as well as the initial poor reduction identified on 3D-reconstructed CT images. Bäcker and Vosseller 5 demonstrated that, in fibular fractures with proximal comminution, the IMN can piston or slide in the fibular shaft, eventually shortening the fibula due to its inherent limited axial stability. Kabukcuoglu et al 18 reported that fibular shortening and lateral displacement were observed in pronation-type comminuted fractures after the unlocked intramedullary device.…”

“…Its concept of achieving closed indirect fracture reduction and relative stability may increase the risk of malunion and the subsequent development of posttraumatic osteoarthritis (PTOA). 2,5,26,43 In addition, a biomechanical study comparing the fibular IMN with the locking plate demonstrated less external rotation stiffness in the fibular IMN than in the plate and hence suggested a strict nonweightbearing protocol to prevent fixation failure following fibular nailing. 36…”

Reoperation Profile of Lateral vs Anterior Approach Ankle Arthroplasty

“…In this study, the 4 patients with fibular nails did not need reoperations for soft tissue or lateral implant removal, which could be indicative of more favorable postoperative implant behavior, compared to the distal fibula plate. 1,11 When closing the lateral approach with a plate, it increases the tension in the deeper layers and decreases the coverage of the plate. Patients with a lateral approach who have a wound complication are more likely to have visible hardware with a plate, which results in more reoperations than if the osteotomy was fixated with a nail.…”

Complications after fibula intramedullary nail fixation of pilon versus ankle fractures

“…Plate fixation of fibula fractures can be complicated by wound dehiscence, infection, loss of fixation, and symptomatic implants in up to 20% of patients. 1,2 In patients with diabetes or vascular disease the risk of complication is even greater, with surgical site infections and wound healing issues being common. 1,3,4 In comparison, intramedullary nail (IMN) fixation of the fibula for ankle fractures results in less wound complications, less implant removals, and similar union rates and functional outcomes.…”