Mid-term Clinical and Functional Outcomes of Fibula Nail Fixation for Unstable Ankle Fractures: a 5-year experience

Joe Barrett-Lee, J. Enson, A. Ahmed, R. Jamal, M. Elmahi, S. N. Anjum

University Hospital Southampton

In recent years fibula nail fixation of unstable ankle fractures has gained increased interest, particularly for high-risk cohorts. As the technique becomes more commonplace, monitoring of outcomes in the longer term is vital. We present the mid-term outcomes of patients treated with fibula nailing at our institution over a 5-year period.

The study period was from December 2016 to December 2021. Our primary outcome measure was the Manchester-Oxford Foot Questionnaire (MOX-FQ), obtained via telephone interview at a mean of 28.9 months post-operatively. Secondary outcomes were complications, metalwork failure, re-operations, and patient satisfaction.

68 patients with unstable ankle fractures underwent fibula nailing during the study period. Mean age was 72 years (SD 12.9) and 79% were female. Mean time to surgery was 5.1 days (SD 4.1) and discharge 14.8 days (20.3). 55 medial malleoli were fixed (21 open, 34 percutaneous). 4 patients (5.9%) underwent metalwork removal: 1 medial malleolus plate, 1 fibula nail and medial screws for deep infection, and 2 syndesmotic screws for pain and prominence. There was one medial-sided surgical site infection, which was treated with antibiotics. 45 patients were contactable for telephone follow-up. The overall mean MOX-FQ score was 27.08 (SD 25.83) and metalwork failure was associated with worse MOX-FQ scores (57.29 failure versus 24.93 non-failure, p=0.034). 38 patients (84%) were satisfied with their outcome.

These Results demonstrate that fibula nail fixation of unstable ankle fractures is associated with a low rate of complications and revisions. Patient-reported outcomes are favourable in most patients.