Fibula Fracture: Plate versus Nail Fixation

Background: Intramedullary fixation has only uncommonly been used in the fibula although it may confer some advantages. Our goal was to investigate a single surgeon's learning curve with initial usage of an intramedullary device for fibular fixation based on surgical time and quality of reduction. Methods: Prior to initiation of this study, an experienced ankle fracture surgeon performed fibular nail fixation in a sawbones and a cadaver setting. Between February and August 2018, all patients who suffered from a distal fibula fracture underwent fibula fixation (n = 20) using the Fibulock (Arthrex). Patients were retrospectively investigated and compared with a control of fibular plate fixation. The tourniquet time, time of anesthesia, and surgery time were recorded as well as the quality of reduction. Results: In the 20 cases, the mean tourniquet time was 68.9 +/- 23.2 minutes for nail fixation, while in the fibular plate fixation group, the mean time was 75.8 +/- 23.9 minutes (p = 0.37). Two patients had slight malreductions (first and third cases): one was corrected with a lag screw outside the nail, the other was an elderly patient with significant blistering in whom an entirely percutaneous reduction was performed. Conclusions: Intramedullary fixation for fibular fractures does not appear to have a significant learning curve for an experienced ankle fracture surgeon.