Intramedullary fixation of fibula fractures: A systematic review

Abstract

Introduction: Distal fibula fractures are common injuries that often require open reduction internal fixation. Intramedullary fixation of the fibula has been used historically, and interest has been renewed somewhat recently, although there is limited data assessing outcomes after intramedullary fibular fixation. The purpose of this study was to systematically evaluate the literature as it relates to the clinical and functional outcome after fibular fracture fixation using an intramedullary device. Methods: A literature review on Medline/Pubmed, EMBASE, Cochrane and Google was performed. In total, 1994 abstracts were reviewed of which 30 articles in English, German and French were included, all of which evaluated the clinical and functional outcome after fibular nail osteosynthesis. Results: Within the 30 studies, a total of 1116/1380 patients were treated with a fibular nail between 1986 and 2018. In total 11 different devices were investigated. Six articles compared fibular nail versus plate osteosynthesis and in five cases a prospective study was performed. The complication rate varied somewhat widely based on the implants used. The mean union rate was 99.1% with a mean follow-up of 19.0 months. In comparison to plate fixation the nail was superior in terms of complication rate in most studies. No unified assessment of functional outcome was used, and so comparison between studies was difficult. However, good and excellent results were obtained in 73%e100% of patients. Conclusion: Current data on intramedullary fixation of the fibula is limited and suffers significantly from inconsistency in outcome reporting. It remains to be seen whether the potential advantages of intramedullary implants can both maintain the good results of other implants and improve on some aspects of more commonly used implants.

Higher complication rate after nail compared with plate fixation of ankle fractures in patients aged 60 years or older: a prospective, randomized controlled trial

“…Nail fixation has shown promising results in the treatment of ankle fractures; however, the evidence is mainly based on small case series and retrospective studies. A recent systematic review by Bäcker et al 28 reported a large variation among the studies which were included, preventing definitive conclusions on the preferred form of treatment. A minimally invasive technique has been considered beneficial in patients with compromised soft-tissues and a high risk of wound complications.…”

Intramedullary nail fixation of fibular fractures in combination with extra-articular distal tibial fractures (AO/OTA 43A): a single-center retrospective study

“…Since then, a less invasive, percutaneous approach and intraosseous fixation have been made possible by the use of intramedullary devices, in which rotation is controlled by distal screws. Thus, the use of a fibular intramedullary nail is currently a common, low risk treatment option for ankle fractures 21,22 , fibular fractures linked to mid-and distal-tibia fractures, and pilon fractures 10,19,23,24 . One benefit of fibular intramedullary fixation is the ability to achieve stability with a smaller incision, which may allow for quicker definitive steadiness in patients with significant edema or fracture blisters.…”

“…One benefit of fibular intramedullary fixation is the ability to achieve stability with a smaller incision, which may allow for quicker definitive steadiness in patients with significant edema or fracture blisters. Additionally, the intramedullary location may result in a lower incidence of hardware removal and peroneal tendon irritation 24 investigated. To further corroborate this findings, a long-term randomized controlled trial research with a larger significant patient and control group and different fixation techniques should be carried out.…”

The Use of Blocking Wires in Fibular Intramedullary Nailing of an Ankle Fracture with Hardware Failure: A Case Report

“…This necessitates open reduction and visualization of the fibula and extent of fracture. Intramedullary nailing is an increasingly used technique for treating these fractures, offering the advantages of smaller incisions for open reduction and nail insertion as well as less soft tissue dissection and preservation of periosteal blood supply, at the price of increased implant cost [4][5][6]. However, certain circumstances, such as comminuted fractures or revision surgeries with previous hardware and screw tracts, can cause the guidewire to deviate resulting in an inability to pass the guidewire or malreduction of the fibula and syndesmosis.…”