Role of Intramedullary Fibular Fixation: Strategies for Addressing Complex Pilon Fractures

Abstract

Aim and background: Pilon fractures are usually the result of a high-energy mechanism and are widely considered more of a soft tissue injury secondary to the high rates of soft tissue complications that arise from them. The majority of pilon fractures have an associated fibular fracture in which minimally invasive intramedullary fixation has been utilized to minimize soft tissue complications. In this manuscript, we present three different cases that highlight different intramedullary fixation techniques. Technique: Cut flexible guidewire, standard cortical screw, intramedullary fibular nail. Conclusion: Intramedullary fixation for associated fibular fractures in the setting of pilon fractures has been shown to be a viable technique for successful outcomes. There are a variety of options for intramedullary fixation that can be utilized, and guidewire, cortical screw, and intramedullary fibular nail techniques are demonstrated in our case examples with tips to help produce good outcomes. Clinical significance: Using minimally invasive intramedullary fibular fixation can help mitigate risk of wound complications in high-risk pilon fractures. Level of evidence: V (expert opinion).

Keywords

• fibula
• fibular
• intramedullary fixation
• pilon
• technique