Evaluation of Retrograde Intramedullary Screw Fixation of the Distal Fibula in Ankle Fractures. | ||
| The Egyptian Orthopaedic Journal | ||
| Articles in Press, Accepted Manuscript, Available Online from 28 May 2025 | ||
| Document Type: Original Article | ||
| DOI: 10.21608/eoj.2025.373202.1029 | ||
| Authors | ||
| Ahmed Hawila* 1; Mohamed Abdel Hameed Romeih2; Mamdouh Fouad Lashin3; Sherif Elsayed El-Daw4 | ||
| 1Department of orthopedic surgery, Tanta University, Egypt. | ||
| 2Professor of Orthopedic Surgery Faculty of Medicine - Tanta University | ||
| 3Professor of Orthopedic Surgery Faculty of Medicine - Tanta University | ||
| 4Lecturer of Orthopedic Surgery Faculty of Medicine - Tanta University | ||
| Abstract | ||
| Background: Distal fibular fractures are the most common ankle fractures. Standard fixation using a lag screw and lateral neutralizing plate carries risks of wound complications and re-operation due to prominent subcutaneous hardware. Retrograde intramedullary screw fixation (RIMSF) may offer a safer, minimally invasive alternative, especially for high-risk patients. Methods: A prospective case series of 30 adult patients with transverse or short oblique distal fibular fractures and intact syndesmosis was conducted at a level 1 trauma center. Patients with syndesmotic injuries, diabetic fractures requiring fusion, or prior ankle deformities were excluded. All patients underwent RIMSF and were followed for at least 12 months. Results: Union was achieved in all patients, with five (16.7%) experiencing delayed union. No deep infections occurred; two patients required systemic antibiotics for superficial wound infections. Four (13.3%) reported skin irritation, and one underwent hardware removal. Anatomical reduction was achieved in 93.3% of cases, with no loss of reduction during follow-up. Most patients returned to pre-injury activity levels. The mean AOFAS hindfoot score was 87.7 ± 6.5, with younger patients showing higher scores (p < 0.041), and comorbidities associated with lower scores (p < 0.001). Conclusion: RIMSF is a reliable, minimally invasive technique for managing transverse and short oblique infra- and trans-syndesmotic distal fibular fractures. It offers high union rates, low complication rates, and good functional outcomes, making it a valuable option in patients at risk of wound complications. However, spiral fractures may be more prone to suboptimal reduction. | ||
| Keywords | ||
| Retrograde intramedullary screw; lateral malleolus; distal fibula; minimally invasive percutaneous fixation | ||
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