Review of Outcomes of Intramedullary Fibular Nails in the Management of Ankle Fractures in Adults

Distal fibula fractures involving the ankle are one of the most common fractures, often requiring open reduction and internal fixation with plates and screws. The increased incidence of potential wound complications arising from open reduction methods led to a rejuvenated interest in the application of minimally invasive methods like intramedullary nailing of the fibula in the management of ankle fractures and isolated distal fibular fractures. A literature search was performed using Medline, Cochrane, and Embase from 1993 to 2023. Search terms included were fibula OR fibular AND nail OR rod OR intramedullary AND open AND closed for Boolean Operators. In total, 740 studies were found based on our search terms, and 33 abstracts that investigated the functional and clinical outcome after intramedullary fixation of a fibular fracture were reviewed and assessed for eligibility. Nine abstracts were subsequently excluded, as they did not meet inclusion criteria, leaving 24 articles to be included in this review. Although there is inconsistency in outcome reporting, intramedullary fibular nails can be considered a viable treatment option for the management of distal fibula fractures and ankle fractures with good clinical results and a lower rate of complications. However, the scope for the application of intramedullary nailing in the management of ankle fractures in older age diabetic age groups with multiple comorbidities is yet to be determined.