Comparison of Ankle Fracture Outcomes Treated with Fibular Nail vs Conventional Fixation

Category: Ankle; Trauma Introduction/Purpose: Ankle fracture fixation can benefit from minimizing postoperative complications, particularly with wound healing and infection. Less invasive implant options necessitating smaller incisions have emerged, including the fibular intramedullary nail (i.e. Arthrex Fibulock) to minimize incisions and potentially allow earlier mobilization. The purpose of this study is to investigate the efficacy and clinical outcomes of a fibular intramedullary nail (Arthrex Fibulock) in ankle fracture treatment across a diverse patient cohort. Methods: A retrospective chart review from 2018 to 2022 was conducted in order to determine eligible patients. Inclusion criteria included adult patients treated for an ankle fracture with at least 3 months of follow-up and sufficient imaging available. Exclusion criteria included open fractures, other concomitant injuries, pilon and tibial shaft fractures, or previous ankle surgery. Results: A total of 132 patients were consecutively included, 44 in the conventional fixation group (33.33%) and 88 in the fibular nail group (66.67%). 4 out of 88 fibular nail patients (4.55%) and 3 out of 44 conventional patients (6.82%) had a postoperative infection (P = .43). 8 fibular nail (9.09%) and 6 conventional (13.64%) fixation patients underwent hardware removal postoperatively, which was not statistically significantly different (P = .55). Conclusion: This study shows no difference between the fibular nail device and a conventional plate and screw fixation approach in the treatment of ankle fractures when looking at postoperative infection and removal of hardware rates. The rate of postoperative infection and hardware removal trended higher in the conventional fixation patients but did not reach statistical significance. As such, the use of the fibular nail may offer a viable alternative for all patients undergoing ankle fracture operative treatment.