Intramedullary Fixation of Distal Fibular Fractures: a Systematic Review of Clinical and Functional Outcomes

Overview

Journal J Orthop Traumatol

Specialties Emergency Medicine
Orthopedics

Date 2014 Oct 12

PMID 25304004

Citations 31

Authors

Sameer Jain

Benjamin A Haughton

Christopher Brew

Affiliations

Soon will be listed here.

Abstract

Background: Ankle 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 Methods: Numerous 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.

Results: Mean 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.

Conclusion: Overall, 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 Evidence: Level IV evidence.

Citing Articles

[Fractures of the upper ankle joint].

Ochman S, Milstrey A, Raschke M Chirurgie (Heidelb). 2025; 96(3):254-268.

PMID: 39951055 DOI: 10.1007/s00104-024-02229-0.

Risk factors for malalignment after intramedullary nail treatment of distal tibia fractures with associated fibula fractures.

Chaudhry Y, Gutierrez-Naranjo J, Raad M, Ghanem D, Salazar L, Goodrum J Eur J Orthop Surg Traumatol. 2024; 34(6):3265-3273.

PMID: 39136728 PMC: 11377517. DOI: 10.1007/s00590-024-04062-x.

Current Trends in the Surgical Treatment of Fibular Fractures: A National Database Study of Intramedullary vs. Plate Fixation Practice Patterns, Complications, and Cost.

Zhang D, Litvak A, Lin N, Pirkle S, Strelzow J, Hynes K Adv Orthop. 2024; 2024:7506557.

PMID: 39036541 PMC: 11260212. DOI: 10.1155/2024/7506557.

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

Acevedo D, Rizzo M, Constantinescu D, Heng M Cureus. 2023; 15(10):e47737.

PMID: 38022253 PMC: 10676240. DOI: 10.7759/cureus.47737.

Current concepts in ankle fractures.

Tansey P, Chen J, Panchbhavi V J Clin Orthop Trauma. 2023; 45:102260.

PMID: 37872976 PMC: 10589378. DOI: 10.1016/j.jcot.2023.102260.

References

Hoiness P, Engebretsen L, Stromsoe K . The influence of perioperative soft tissue complications on the clinical outcome in surgically treated ankle fractures. Foot Ankle Int. 2001; 22(8):642-8. DOI: 10.1177/107110070102200805. View

Ware Jr J, Kosinski M, Keller S . A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996; 34(3):220-33. DOI: 10.1097/00005650-199603000-00003. View

Kristensen K, Hansen T . Closed treatment of ankle fractures. Stage II supination-eversion fractures followed for 20 years. Acta Orthop Scand. 1985; 56(2):107-9. DOI: 10.3109/17453678508994330. View

Ebraheim N, Savolaine E, Patel A, Skie M, Jackson W . Assessment of tibial fracture union by 35-45 degrees internal oblique radiographs. J Orthop Trauma. 1991; 5(3):349-50. DOI: 10.1097/00005131-199109000-00015. View

Court-Brown C, Caesar B . Epidemiology of adult fractures: A review. Injury. 2006; 37(8):691-7. DOI: 10.1016/j.injury.2006.04.130. View

Mast J, Teipner W . A reproducible approach to the internal fixation of adult ankle fractures: rationale, technique, and early results. Orthop Clin North Am. 1980; 11(3):661-79. View

Lamontagne J, Blachut P, Broekhuyse H, OBrien P, Meek R . Surgical treatment of a displaced lateral malleolus fracture: the antiglide technique versus lateral plate fixation. J Orthop Trauma. 2002; 16(7):498-502. DOI: 10.1097/00005131-200208000-00008. View

Ramasamy P, Sherry P . The role of a fibular nail in the management of Weber type B ankle fractures in elderly patients with osteoporotic bone--a preliminary report. Injury. 2001; 32(6):477-85. DOI: 10.1016/s0020-1383(01)00030-4. View

Sirkin M, Sanders R, Dipasquale T, Herscovici Jr D . A staged protocol for soft tissue management in the treatment of complex pilon fractures. J Orthop Trauma. 1999; 13(2):78-84. DOI: 10.1097/00005131-199902000-00002. View

10.

McLennan J, Ungersma J . Evaluation of the treatment of ankle fractures with the Inyo nail. J Orthop Trauma. 1988; 2(4):272-6. DOI: 10.1097/00005131-198802040-00002. View

11.

Baird R, Jackson S . Fractures of the distal part of the fibula with associated disruption of the deltoid ligament. Treatment without repair of the deltoid ligament. J Bone Joint Surg Am. 1987; 69(9):1346-52. View

12.

Lee Y, Chen S . Lateral fixation of open AO type-B2 ankle fractures: the Knowles pin versus plate. Int Orthop. 2008; 33(4):1135-9. PMC: 2899001. DOI: 10.1007/s00264-008-0617-9. View

13.

Yde J, Kristensen K . Ankle fractures. Supination-eversion fractures stage II. Primary and late results of operative and non-operative treatment. Acta Orthop Scand. 1980; 51(4):695-702. DOI: 10.3109/17453678008990863. View

14.

Gehr J, Neber W, Hilsenbeck F, Friedl W . New concepts in the treatment of ankle joint fractures. The IP-XS (XSL) and IP-XXS (XXSL) nail in the treatment of ankle joint fractures. Arch Orthop Trauma Surg. 2003; 124(2):96-103. DOI: 10.1007/s00402-003-0606-9. View

15.

Jacobsen S, Honnens de Lichtenberg M, Jensen C, Torholm C . Removal of internal fixation--the effect on patients' complaints: a study of 66 cases of removal of internal fixation after malleolar fractures. Foot Ankle Int. 1994; 15(4):170-1. DOI: 10.1177/107110079401500402. View

16.

Lee Y, Huang H, Lo T, Huang C . Lateral fixation of AO type-B2 ankle fractures in the elderly: the Knowles pin versus the plate. Int Orthop. 2006; 31(6):817-21. PMC: 2266675. DOI: 10.1007/s00264-006-0260-2. View

17.

Bugler K, Watson C, Hardie A, Appleton P, McQueen M, Court-Brown C . The treatment of unstable fractures of the ankle using the Acumed fibular nail: development of a technique. J Bone Joint Surg Br. 2012; 94(8):1107-12. DOI: 10.1302/0301-620X.94B8.28620. View

18.

Ray T, Nimityongskul P, Anderson L . Percutaneous intramedullary fixation of lateral malleolus fractures: technique and report of early results. J Trauma. 1994; 36(5):669-75. DOI: 10.1097/00005373-199405000-00012. View

19.

Olerud C, Molander H . A scoring scale for symptom evaluation after ankle fracture. Arch Orthop Trauma Surg (1978). 1984; 103(3):190-4. DOI: 10.1007/BF00435553. View

20.

Yablon I, Heller F, Shouse L . The key role of the lateral malleolus in displaced fractures of the ankle. J Bone Joint Surg Am. 1977; 59(2):169-73. View