The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

Distal Fibula Pro-Tibial Screws in Salvage Fixation of Bimalleolar Ankle Fractures in Osteoporotic Bone – A Novel Technique

Document Type : CASE REPORT

Authors
Mostafa Beshr
James Dixon
Iain Stevenson
Aberdeen Royal Infirmary, Aberdeen, United Kindom
10.22038/abjs.2024.76119.3515
Abstract
Here we present a novel adaptation of the previously described fibula pro -tibial fixation in a case 
requiring salvage fixation of a bimalleolar ankle fracture in an osteoporotic patient. Unstable 
osteoporotic ankle fractures are a challenging injury to manage and typically occur in a frail and 
comorbid subgroup of patients. Various techniques have been described in the evolution of managing 
these injuries, e.g. hindfoot nailing and anatomical locking plates, however in this uniquely challenging 
case a novel strategy was required to mitigate bone loss in the distal fibular fracture fragment. There 
is some evidence to suggest fibular protibial fixation offers a lower complication profile to its 
alternatives. The novel use of distal fibula pro-tibial screws offers a new alternative to hindfoot nailing 
of bimalleolar ankle fracture in osteoporotic bone with compromised distal fibular fragment bone 
purchase. Further research is required to investigate the compatibility of this technique with early 
weightbearing.
 Level of evidence: IV
Keywords
Ankle
Bone failure
Osteoporosis
Revision fixation
Salvage fixation
Subjects
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The Archives of Bone and Joint Surgery
Volume 12, Issue 5
May 2024
Pages 361-364

  • Receive Date 08 November 2023
  • Revise Date 29 April 2024
  • Accept Date 07 January 2024