Fibular Intramedullary Nailing in Ankle Fracture Management

Ankle fractures are among the most common orthopaedic injuries, frequently necessitating surgical intervention to restore joint alignment and function. Although open reduction and internal fixation (ORIF) with plates and screws has traditionally been the gold standard, it is associated with notable postoperative complications—particularly in patients with multiple comorbidities or compromised soft tissue. Intramedullary (IM) fibular nails have emerged as a minimally invasive alternative, offering comparable biomechanical stability with reduced complication rates, expedited recovery, and increasing cost-effectiveness. This report reviews the clinical rationale and evolving role of fibular IM nails, with particular attention to the Arthrex FibuLock system. We also present a case involving a 50-year-old woman with a trimalleolar Weber B ankle fracture treated successfully using a combination of IM nailing and ORIF, highlighting the technique’s utility in achieving anatomic reduction and stable fixation. This educational resource is intended to inform orthopaedic physician assistants about the expanding role of fibular IM nails in contemporary ankle fracture management.