Minimally Invasive Fixation of a Distal Fibula Fracture With an Intramedullary Nail.

Abstract

Background: Advantages of using an intramedullary (IM) nail over a lateral plate for fixation of distal fibula fractures include the ability to allow for earlier weightbearing and return to sport, smaller incisions, and decreased hardware prominence. When comparing a fibular nail with an IM screw, the nail allows for syndesmosis fixation through the device and imparts rotational stability. Long-term studies support the viability and clinical outcomes of using an IM nail. In this technique video, a case is presented to illustrate the use of an IM nail for fixation of a distal fibula fracture.

Indications: Distal fibula fractures should be treated operatively in the following cases: open fractures, bimalleolar fractures, or lateral malleolar fractures with medial clear space widening, displacement >3 mm, or decreased tib-fib overlap, increased talocrural angle, any talar displacement, fracture-dislocation, or nonunion. When treating these fractures operatively, it is crucial to get an anatomic reduction, as this will lead to a satisfactory outcome. By restoring the anatomy, the talar shift is decreased, and a normal tibiotalar contact area is approached.

Technique description: Percutaneous incisions are made around the fracture to place a clamp and hold anatomic reduction. Once reduced, a small incision is made 1cm distal to the fibular tip and in line with its axis. The start point is checked with the K-wire on anteroposterior and lateral views. An opening reamer is used, followed by a flexible guidewire and then a proximal reamer. Talons are deployed once the appropriate position is confirmed, and interlocking screws are placed through the guide. Syndesmosis fixation is added if necessary.

Results: The success rate for achieving good outcomes is high at 90%. Patients should be counseled that their braking time while driving is normal at around 9 weeks and that overall recovery is about 2 years.

Discussion/conclusion: This technique should not be used if the 6.2-mm opening reamer will breach the cortex, and should not be used if a plate will provide superior fixation. Like with any nailing procedure, obtaining and maintaining the reduction is paramount. A proper start point is critical for optimal fixation.

Patient consent disclosure statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.