Ankle fracture fixation using a novel flexible intramedullary fibular nail and alignment guide affording syndesmotic re-alignment along the centroidal axis

Abstract

Reported advantages of ankle fracture fixation using intramedullary fibular (IMF) nails over traditional plates/screws include: earlier weightbearing, reduced wound complications, better union rates, and the absence of prominent hardware. The purpose of present case series was to assess the early clinical and radiographic outcomes of patients who underwent ankle fracture fixation using a novel, flexible IMF nail affording syndesmotic realignment along the centroidal axis. Demographic, clinical, and radiographic data were recorded for all patients who underwent after ankle fracture fixation using a novel, flexible IMF with syndesmotic realignment between May 2021 and May 2022, and who were at least 6 months postoperative. Toe-touch weightbearing was permitted immediately after surgery, protected weightbearing (PWB) at postoperative week 2, and weightbearing as tolerated in a brace at week 6. Formal physical therapy commenced at postoperative week 8. Radiographs were assessed preoperatively, and at 2, 6, 12, 24, and 48 weeks postoperative. Twenty-three ankles with a mean follow up of 6.9 (range, 6 to 11) months were included. Overall, painless weightbearing without any residual swelling and stiffness was documented in all but 1 patient, and mean time to union was 11.5 (range, 6 to 24) weeks. Eighteen ankles (78%) showed complete union at 12 weeks postoperative, while 5 (AO/OTA B1.2, B2.1/3, B3.1/3) showed progressive signs radiographic union without clinical symptoms; all progressed to union by 24th weeks postoperative. Reduction and alignment maintenance was observed in all ankles during the most recent follow-up, and no complications/reoperations related to the IMF nail were recorded. A total of 6 complications unrelated to the IMF nail were recorded, and 2 ankles required reoperation. A history of tobacco was associated with delayed union (p=0.02). Short-term follow-up for ankle fractures fixated using a flexible, IMF nail with concurrent syndesmotic realignment along the centroidal axis showed painless weightbearing and complete radiographic union, without any complications/reoperations related to the IMF; irrespective of fracture morphology.

Keywords

• Level IV, retrospective case series