Fibular nailing for fixation of ankle fractures in patients at high risk of surgical wound infection

Abstract Background Postoperative infection is a severe complication after operative treatment of ankle fractures, associated with age, comorbidities, and severe soft tissue injuries. We assessed the efficacy of intramedullary fibular nailing for treating ankle fractures in patients at high risk of wound complications. Methods 41 high-risk patients were included in the study. We retrospectively reviewed the medical records to assess the risk profile, the treatment data, and possible infections and re-operations. After a minimum of 2 years eight patients had died, three had advanced-staged dementia and two were lost to follow-up. Remaining 28 patients reported the functional outcome and QoL through patient-reported questionnaires. Radiographs and cone-beam computed tomography were performed, as well as range-of-motion was measured. Results No surgical wound infections were found. The mean Olerud-Molander score was 67 points (SD 28 [20 – 100]). The osteoarthritis stages and the range-of-motion were significantly different between the injured and uninjured ankles, but we detected no significant effect on the QoL. Conclusion Intramedullary fibular fixation appeared to be a safe treatment choice for ankle fractures in high-risk patients. Level of Evidence IV