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Ankle fractures are among the most common injuries seen by orthopedists comprising 9% of all fractures, and the incidence continues to rise because of the epidemic of osteoporosis in the aging population. Of these fractures, more than 90% involve the distal fibula. The most common ankle fractures result from torsional stress about the ankle, which leads to oblique fractures of the distal fibula. Little has changed in the fixation strategies of distal fibular fractures since osteosynthesis was first introduced. The posterior plate has been proposed as a substitute for the lateral plate, trading the concern of hardware prominence for that of peroneal irritation. Locking technology has been utilized in patients with poor bone stock or very distal fragments. These 2 methods of fixation carry an overall complication rate up to 30%, with wound infections seen in 26% to 40%. Intramedullary fixation of fibula fractures was first described by the use of the Inyo nail in 1986. This device was made with malleable stainless steel and attempted to maintain rigid fixation using a triflange wedge fit. This technique was fraught with complications secondary to nail migration and malunion. In other early intramedullary designs, rotational and length instability continued to lead to malreduction and poor radiographic results. Modern design changes and the use of locking screw technology have been used in an attempt to overcome many of the shortcomings of early-generation devices. Exposure for intramedullary fixation of fibular fractures requires less soft tissue dissection and inherently less hardware prominence and periosteal stripping. This technique offers an alternative to traditional plating and looks to improve on the most common complications. Intramedullary fixation is a load-sharing device, and in a recent biomechanical study, it provided a higher load to failure than traditional plate fixation in osteoporotic bone. Indications

Intramedullary Fixation for Fractures of the Distal Fibula