The implants used for intramedullary fixation of distal fibula fractures: A review of literature

Abstract

Background: Ankle fractures are amongst the most common surgically treated musculoskeletal injuries. Intramedullary (IM) fixation of the lateral malleolus had been attempted as early as the 1990s. In recent years, dedicated implants have emerged. This review evaluates the design characteristics of the technology used to perform IM fixation of distal fibular fractures.

Materials and methods: A search of electronic databases was performed. Medical subject headings (MeSH) and free-text terms were used to optimise search sensitivity and specificity.

Results: We identified 10 different surgical technologies for IM fixation of lateral malleolar fractures reported across 12 articles, including both improvised and custom-designed Orthopaedic implants. Most implants were inserted through percutaneous surgical techniques.

Conclusion: Advances in technology have improved the feasibility of intramedullary fixation as a treatment option for lateral malleolus fractures. The implants we reviewed had very diverse morphological and mechanical properties. Intra-medullary fixation may outperform extra-medullary fixation of the lateral malleolus, particularly in patients at high risk of soft tissue complications. Robust scientific evidence is awaited.

Level of evidence: Level IV evidence.

Keywords: Fibula; Fracture; Intramedullary; Lateral malleolus; Nail.