{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T18:32:09Z","timestamp":1793298729540,"version":"4.5.0"},"reference-count":24,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:sec>\n            <jats:title>OBJECTIVES:<\/jats:title>\n            <jats:p>To describe and report outcomes of a minimally invasive open fibular intramedullary (IM) nailing technique for fixation of ankle fractures.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>METHODS:<\/jats:title>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Design:<\/jats:title>\n            <jats:p>Case Series.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Setting:<\/jats:title>\n            <jats:p>Urban Level 1 trauma center.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Patient Selection Criteria:<\/jats:title>\n            <jats:p>Adult patients with ankle fractures (OTA 44A-C) treated with locked fibular IM nailing through a minimally invasive open technique for fracture and syndesmotic reduction between 2021 and 2024.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Outcome Measures and Comparisons:<\/jats:title>\n            <jats:p>Quality of reduction, complications, and patient-reported outcomes.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS:<\/jats:title>\n            <jats:p>A total of 150 consecutive patients operated by a single surgeon were included. Mean age was 53.3 (17\u201397) years, and mean body mass index was 30.6 \u00b1 7.4 kg\/m<jats:sup>2<\/jats:sup>. Ninety-three (62%) patients were female, and 78 (52%) patients were White. Seventy-two (48%) patients were obese, 40 (27.7%) patients were current\/former smokers, 39 (26%) patients had diabetes, and 23 (15.3%) patients had open fractures. Thirty-seven (24.7%) patients had isolated lateral malleolus fractures, 48 (32%) had bimalleolar fractures, and 65 (43.3%) had trimalleolar fractures. One hundred and twenty-three (82%) patients had 2 syndesmotic screws placed, 26 patients (17.3%) had 1 screw, and 1 patient (0.7%) had none. Quality of reduction was good for 98%, fair for 2%, and poor for none per McLennan criteria. One hundred thirteen patients (75.3%) were followed until clinical and radiographic union for a mean of 7.6 months (range 3\u201322) months. One hundred and ten patients (97.3%) went on to successful clinical and radiographic union after the index procedure. No patient had a superficial surgical-site infection, and 3 (2.6%) had deep surgical-site infections. Three patients had a loss of reduction, and 6 patients had implant failure (5 broken syndesmotic screws, and 1 medial malleolus screw). Nine (8%) patients had unplanned reoperations (3 for debridement, 2 for loss of reduction, and 4 for removal of symptomatic implants). Mean ankle range of motion at final follow-up visit was 12.9 degrees (0\u201340) of dorsiflexion, 39.6 degrees (10\u201370) of plantar flexion, 23.5 degrees (5\u201340) of inversion, and 18.2 degrees (5\u201350) of eversion. Mean PROs at final follow-up visit were Global Physical Health: 42.4 (23.5\u201367.6), Global Mental Health: 47.5 (21\u201367.6), Physical Function: 37.5 (14.7\u201357.8), Pain: 54.9 (22\u201372), and Mobility: 36.9 (16\u201365.3).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSIONS:<\/jats:title>\n            <jats:p>Minimally invasive open fibular IM nailing allowed for excellent reduction and results in union with low rates of complications and good patient-reported outcomes.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>LEVEL OF EVIDENCE:<\/jats:title>\n            <jats:p>Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/bot.0000000000002908","type":"journal-article","created":{"date-parts":[[2024,9,9]],"date-time":"2024-09-09T19:17:24Z","timestamp":1725909444000},"page":"1-7","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":8,"title":["Ankle Fractures Treated With Locked Fibular Intramedullary Nailing: Description and Outcomes of a Minimally Invasive Open Technique"],"prefix":"10.1097","volume":"39","author":[{"given":"Cassandra","family":"Ricketts","sequence":"first","affiliation":[{"name":"Orthopaedic Trauma Service, Florida Orthopaedic Institute, Tampa, FL; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5871-4741","authenticated-orcid":false,"given":"Mir Ibrahim","family":"Sajid","sequence":"additional","affiliation":[{"name":"Orthopaedic Trauma Service, Florida Orthopaedic Institute, Tampa, FL; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-1008-3278","authenticated-orcid":false,"given":"Meghan","family":"McCaskey","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, University of South Florida, Tampa, FL."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reed","family":"Andrews","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, University of South Florida, Tampa, FL."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0260-3468","authenticated-orcid":false,"given":"Hassan R.","family":"Mir","sequence":"additional","affiliation":[{"name":"Orthopaedic Trauma Service, Florida Orthopaedic Institute, Tampa, FL; and"},{"name":"Department of Orthopaedics, University of South Florida, Tampa, FL."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-20241213","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1016\/j.injury.2006.04.130","article-title":"Epidemiology of adult fractures: a review","volume":"37","author":"Court-Brown","year":"2006","journal-title":"Injury"},{"key":"R2-20241213","doi-asserted-by":"crossref","first-page":"1184","DOI":"10.3113\/FAI.2008.1184","article-title":"Ankle fractures in the elderly: initial and long-term outcomes","volume":"29","author":"Anderson","year":"2008","journal-title":"Foot Ankle Int"},{"key":"R3-20241213","doi-asserted-by":"crossref","first-page":"1394","DOI":"10.1177\/1071100717731757","article-title":"Biomechanical comparison of intramedullary fibular nail versus plate and screw fixation","volume":"38","author":"Smith","year":"2017","journal-title":"Foot Ankle Int"},{"key":"R4-20241213","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1186\/s13018-016-0435-5","article-title":"A biomechanical comparison study of a modern fibular nail and distal fibular locking plate in AO\/OTA 44C2 ankle fractures","volume":"11","author":"Switaj","year":"2016","journal-title":"J Orthop Surg Res"},{"key":"R5-20241213","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1177\/1938640021991735","article-title":"Intramedullary fixation of distal fibula fractures","volume":"16","author":"Umbel","year":"2023","journal-title":"Foot Ankle Spec"},{"key":"R6-20241213","doi-asserted-by":"crossref","first-page":"1911","DOI":"10.1007\/s00068-020-01337-w","article-title":"Nailing the fibula: alternative or standard treatment for lateral malleolar fracture fixation? 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