Optimizing Long-Term Outcomes and Avoiding Failure With the Fibula Intramedullary Nail

Area of Science:

• Orthopaedic surgery
• Trauma management
• Biomechanical fixation

Background:

• Unstable ankle fractures require surgical stabilization.
• Fibula nail fixation is a common technique.
• Understanding failure modes is critical for improving outcomes.

Purpose of the Study:

• Identify risk factors for fibula nail fixation failure in unstable ankle fractures.
• Report patient outcomes following this procedure.
• Provide recommendations for surgical technique modification.

Main Methods:

• Retrospective review of 342 patients with unstable ankle fractures treated with fibula nails.
• Analysis of short-term failure (revision surgery) and mid-term outcomes (Olerud-Molander Ankle Score, Manchester-Oxford Foot Questionnaire).
• Evaluation of device failure and surgeon error as causes of fixation failure.

Main Results:

• Overall fixation failure rate was 6% (20 patients).
• Device failure (proximal locking screw pull-out) occurred in 2%, associated with PLS positioning >20 mm above the plafond.
• Surgeon error (inappropriate weight-bearing, inadequate reduction/placement) accounted for 4% of failures.
• Mid-term patient-reported outcomes were generally good, unaffected by revision surgery.

Conclusions:

• Fibula nail fixation provides secure stabilization for unstable ankle fractures with favorable patient outcomes.
• Meticulous surgical technique, particularly proximal locking screw placement, is essential.
• Appropriate postoperative management is vital to minimize construct failure risk.