DOI: 10.1177/24730114261500036 ISSN: 2473-0114

Operative Time and Complication Rates After Treatment of Rotational Ankle Fractures With Fibula Intramedullary Nailing vs Plating

Hannah M. Thomas, Christopher Cuneo, Jordan Slaton, Emily Tse, Michael S. Kim, Justin Haghverdian, Philip K. Lim
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Background:

This study investigates outcomes of intramedullary nailing of fibula fractures compared with conventional fixation with a plate/screws construct.

Methods:

This is a single-center retrospective cohort study. Inclusion criteria were age ≥18 years, rotational ankle fracture pattern, minimum 3 months of follow-up, and surgery date between January 2018 and June 2024. Outcomes analyzed were operative time, surgical site infection, symptomatic hardware, and return to operating room (OR). The operative time analysis was performed using a Student t test and multivariable linear regression analysis. Unadjusted analysis of complications was first performed using Fisher exact tests. A Kaplan-Meier time-to-event analysis was performed for each complication variable and a weighted Cox proportional hazards model of surgical site infection and return to OR was constructed using inverse probability weighting.

Results:

A total of 236 patients were included (36 intramedullary nails [IMN], 200 plate/screws). Operative time was shorter in the IMN group (mean 92 minutes) than the plate group (mean 148 minutes, P < .001). At a fixed time point of 12 months, the Kaplan-Meier estimated cumulative incidence of symptomatic hardware was 11.1% in the plate group and 0% in the IMN group. In the weighted Cox models, no significant difference could be detected in the hazard of surgical site infection (hazard ratio [HR] 0.57, 95% CI 0.08-4.33; P = .589) or return to the OR (HR 0.59, 95% CI 0.08-4.35; P = .605) between groups.

Conclusion:

IMN fixation was associated with shorter operative times than plating. With the numbers available, no significant difference could be detected in the hazard of surgical site infection or return to OR. No symptomatic hardware events occurred in the IMN group, although only 5 of 36 IMN patients reached 12 months of follow-up and an adjusted comparison was not possible. These results suggest that intramedullary nailing may be an expeditious and soft tissue–friendly alternative to plate osteosynthesis.

Level of Evidence:

Level III, retrospective comparative study.

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