Abstract
The traditional method of treating fibular fractures in unstable ankle injuries involves
open reduction and internal fixation with a plate and screw construct. Less invasive
percutaneous fixation techniques with intramedullary fibular screws have been utilized
for many years to reduce wound and implant complications while maintaining a stable
ankle mortise. However, there have been no direct case-control studies comparing percutaneous
intramedullary fibular screw fixation to the traditional open reduction and internal
fixation with plates and screws. In our study, we compared radiographic and clinical
outcomes for unstable ankle fractures in which the fibula fracture was treated with
either a percutaneous intramedullary screw or by open reduction and internal fixation
with a plate and screw construct. We retrospectively reviewed 69 consecutive patients
from 2011 to 2019 with unstable ankle fractures treated with intramedullary fibular
screws and compared them to 216 case-control patients treated with traditional plate
and screw construct over the same time period. The average follow-up for the intramedullary
screw group was 11.5 months and 15.2 months for the plate and screw group. We collected
general demographic data, measured intraoperative and final follow-up talocrural angles,
Kellgren-Lawrence osteoarthritis grade, union rates, implant removal rates, infection
rates, and American Orthopedic Foot and Ankle Society ankle-hindfoot scores. The intramedullary
screw group had a statistically significant lower rate of delayed implant removal
(8.7% vs 23.6%) and there was no detectable difference in other measures.
Level of Clinical Evidence
Keywords
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Article info
Publication history
Published online: September 20, 2022
Footnotes
Financial Disclosure: None reported.
Conflict of Interest: BCT is on the speakers’ bureau, is a consultant, and receives royalties from ZimmerBiomet; he receives royalties from Innomed, and he also is on the editorial board of Orthobullets.com and holds stock interest in Orthobullets.com. For the remaining authors, none are reported.
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© 2022 by the American College of Foot and Ankle Surgeons. All rights reserved.
