Innovative approach to intramedullary nailing of the fibula: a technical note

Traditionally unstable ankle fractures are surgically managed using open reduction and internal fixation (ORIF) with plate and screws. However, the operative management has gained an innovative technique. In the last decade, intramedullary (IM) nailing was introduced in local guidelines as a treatment for a selective group of elderly patients with compromised soft-tissues, as this technique is minimally invasive and less prone to wound complications including infections. Based on the authors' experience with IM nailing of the fibula using an intramedullary locking fibula nail, common technical challenges are highlighted and tips and tricks are provided to achieve optimal anatomic reduction by optimizing the entry point of the nail. Furthermore, we introduce a flow-diagram for optimal anatomic reduction using a dorsolateral entry point for the nail.