Assessing the Safety of Fibular Nailing

by Vince Vacketta, DPM

Intramedullary fibular nailing (IMFN) offers unique advantages over traditional plate and screw techniques for open reduction and internal fixation (ORIF) of fibula fractures. However, the risk of iatrogenic soft tissue and nerve damage remains a concern. 

A cadaveric study evaluated the structured impact of a single IMFN construct in 10 specimens.

Study results

The study found that the peroneus brevis tendon was within 5 mm of the distal skin incision in all specimens and within 5 mm of the nail aperture in 60% of cases. The peroneus longus tendon faced moderate-to-high risk during syndesmotic screw placement in 90% of specimens. The superficial peroneal nerve was at high risk in 70% of specimens during distal anterior to posterior locking screw insertion. Additionally, the calcaneofibular ligament was damaged in three out of 10 specimens, with damage ranging from 14% to 64% of its width.

Key insights

While IMFN is minimally invasive, it can still cause iatrogenic injuries. Careful consideration of local anatomy and implant selection is imperative to avoid injury.