Fibular nailing is associated with fewer complications in high-risk ankle fractures: A propensity score-matched case-control study.

PURPOSE: Ankle fractures are common, with higher complication rates in elderly, comorbid patients and those with complex injury patterns. Minimally invasive techniques such as intramedullary fibular fixation have gained interest for their potential to reduce morbidity. This study compared outcomes of fibular nailing versus plating in high-risk ankle fractures and aimed to identify the patient profile most likely to benefit from intramedullary fixation.

METHODS: A retrospective, propensity score-matched case-control study was conducted at a level I Trauma Center. Patients with low-energy rotational ankle fractures treated with either an intramedullary fibular nail (Fibula Rod System, Acumed) or a locking plate were included. Matching was based on age, ASA score, open fracture, fracture-dislocation, and soft tissue condition. Outcomes included postoperative complications, operative time, hospital stay, and time to full weight-bearing.

RESULTS: A total of 204 patients were analyzed (51 treated with fibular nailing and 153 with plate fixation). Nailing was performed in older patients (mean age 67.7 years) with relevant comorbidities (mean ASA score 2.2) and complex injuries, including open fractures (17.6%), fracture-dislocations (39.2%), and soft tissue compromise (58.8%). After matching, baseline characteristics were comparable between groups. The nailing group showed fewer major complications (3.9% vs. 18.3%, p = 0.01), no minor complications (vs. 19.0%, p < 0.01), shorter operative time (63.1 vs. 100.6 min, p < 0.01), and earlier full weight-bearing (36.0 vs. 51.1 days, p < 0.01).

CONCLUSION: Intramedullary fibular nailing appears to be a safe and effective alternative to plating in high-risk, complex ankle fractures.