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If I have a Hammer Everything Starts to Look like a Nail

Updated: Sep 1, 2021

IM nails for fibula fractures is the proposition

Intramedullary nailing of fibula fractures with the advocates citing decreased wound complications, the absence of hardware prominence, lower non-union rate and less overall cost.

Not so fast

Authors of Midterm Outcomes of Unstable Ankle Fractures in Young Patients Treated by Close Reduction and Fixation With an Intramedullary Fibular Nail vs Open Reduction Internal Fixation using a lateral Locking Plate report poorer reduction and a higher incidence of post-traumatic arthritis in patients under-going intramedullary nailing versus traditional ORIF. These results were observed in Weber C type injuries, comminuted fibular fractures and tri-malleolar fracture patterns.

The verdict

Not yet out, but likely this is an appropriate technique for stable fibula fractures where length and rotation is not the challenge. TBA whether the increased cost of an IM implant over traditional ORIF is worth the squeeze. This screams of another debate for the trauma-focused versus foot-and-ankle-focused surgeons.

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