Surgical Technique

Fibula Rod System

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Acumed® Fibula Rod System Fibula Rod System

Acumed’s Fibula Rod System represents an alternative to the Surgical Technique
use of ORIF for unstable ankle fractures. Open reduction of ankle Paul T. Appleton, M.D.
fractures has been associated with high rates of deep wound Tim White, M.D., FRCS
sepsis, particularly in the elderly and diabetics, and in patients
where the soft tissue envelope is swollen and blistered. 1 Retained
hardware under the lateral malleolar incision is also a common
source of skin and soft tissue irritation and discomfort. 1
Acumed’s goal is to provide excellent fracture stability through
a minimally invasive procedure. Incorporating a straightforward
targeting guide, the Fibula Rod and the interlocking screws can be
inserted via small incisions, which may reduce some of the surgical Contents
complications associated with ORIF.
Introduction 2
Indications for Use: Fibula Rod Surgical Technique 3
Lateral Malleolus Fractures including unstable ankle fractures with Ordering Information 6
talar subluxation Notes 7
1. Appleton, Paul M.D.; McQueen, Margaret M.D.; Court-Brown, Charles M.D. The
Fibula Nail for Treatment of Ankle Fractures in Elderly and High Risk Patients,
Techniques in Foot & Ankle Surgery. 5(3):204-208, September 2006
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 Acumed® Fibula Rod System Surgical Technique

Fibula Rod System

Paul T. Appleton, M.D. and Tim White, M.D., FRCS

1
INCISION
Make a 1.5 cm longitudinal incision 1 cm distal to the
tip of the fibula. Reduction of the fracture may be
achieved by using forceps percutaneously or by using a guide
wire in the distal segment of the fibula.

2
ENTRY POINT
The entry point is the distal tip of the fibula.
Establish the entry point with the .062" (1.6 mm) x 6"
Guide Wire (WS-1607ST), using fluoroscopy in both A/P and
lateral planes.

3
CANAL PREPARATION
The distal 4 cm of the fibula is drilled with the
cannulated, 6.1 mm Fibula Rod Intramedullary Drill
(40-0111) over the guide wire (full depth of the drill flutes). The
diaphyseal canal is then sequentially reamed with the reamers
(RMT3130 and RMT3730) while holding the reduction.

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 Acumed® Fibula Rod System Surgical Technique

Back Table Assembly

Targeting Guide
Assemble the Fibula Rod Targeting Guide (40-0032), Fibula
Rod angles toward Rod Base Plate (40-0034), Fibula Rod A/P Targeting Guide
Targeting Guide (40-0036), and Fibular Rod Locking Bolt (40-0113) to the
(assembly)
selected fibula rod as shown.

A/P Guide

Locking Bolt

Base Plate

4
ROD INSERTION
Prior to inserting the A/P screw, the targeting guide
(assembly) should be rotated approximately 25º
posteriorly to allow for (a) some internal rotation during fracture
reduction, when required, and (b) anatomical placement of the
lateral screw from the fibula to the center of the tibia, which
requires a slight posterior to anterior orientation.

5
A/P SCREW(S) INSERTION
Insert the 3.5 mm Targeting Cannula (HR-3101)
and the 3.5 mm Drill Guide (40-0038) into one of
the A/P holes targeting the distal fragment, then make a stab
incision to allow the cannula and drill guide to be advanced to
bone. Drill to the second cortex and measure. Insert a cortical
screw that reaches, but does not penetrate, the posterior
cortex (to avoid peroneal tendon irritation). One or two screws
can be inserted according to preference.

4
 Acumed® Fibula Rod System Surgical Technique

6
FRACTURE REDUCTION
The distal fragment is now secured to the Fibula
Rod (40-00XX-S), which in turn is securely attached
to the targeting guide (assembly). Use the assembly and gentle
controlled movements to reduce the ankle mortise anatomically.
For example, Supination External Rotation Ankle fractures will
typically involve gentle traction and internal rotation. Careful
confirmation of adequate reduction using fluoroscopy
is recommended.

7
LATERAL SCREW(S) INSERTION
Maintain the reduction manually and insert the
targeting cannula and drill guide into one of the
lateral to medial holes in the targeting guide (assembly), again
making a stab incision to allow the cannula and drill guide to
be advanced to bone. Ensure the cannula and guide have a
slight posterior-to-anterior orientation. Drill through at least
three cortices and insert appropriate length cortical screw. The
Fibula Rod is now locked, preventing longitudinal or rotational
displacement, and the lateral buttress of the mortise is now stable.
Note:  This step is recommended regardless of the mechanical
instability of the syndesmosis.

8
CLOSURE AND
POSTOPERATIVE PROTOCOL
After removal of the targeting guide (assembly)
from the Fibula Rod, the skin can be closed using the
surgeon’s preferred method. The patient can usually be
allowed full weight-bearing, but may be restricted according to
the surgeon’s judgement and preference.

5
 Ordering Information

Fibula Rod Implants Fibula Rod Instruments

3.0 mm x 110 mm Fibula Rod 40-0026-S Fibula Rod Targeting Guide 40-0032

3.0 mm x 145 mm Fibula Rod 40-0027-S Fibula Rod Base Plate 40-0034

3.0 mm x 180 mm Fibula Rod 40-0028-S Fibula Rod A/P Targeting Guide 40-0036

3.6 mm x 110 mm Fibula Rod 40-0029-S Fibula Rod Awl 40-0037

3.6 mm x 145 mm Fibula Rod 40-0030-S 3.5 mm Drill Guide 40-0038

3.6 mm x 180 mm Fibula Rod 40-0031-S 2.8 mm Fibula Rod Drill 80-0642

Fibula Rod Intramedullary Drill 40-0111

3.5 mm Cortical Screws
Fibula Rod Locking Bolt 40-0113
3.5 mm x 8 mm Cortical Screw CO-3080
3.5 mm Targeting Cannula HR-3101
3.5 mm x 10 mm Cortical Screw CO-3100
2.5 mm Solid Quick Release Driver Tip HT-2502
3.5 mm x 12 mm Cortical Screw CO-3120
3.5 mm Screw Driver Sleeve MS-SS35
3.5 mm x 14 mm Cortical Screw CO-3140
Locking Bolt Finger Wrench MS-0611
3.5 mm x 16 mm Cortical Screw CO-3160
Rosette Knob MS-0100
3.5 mm x 18 mm Cortical Screw CO-3180
Generic Cannula (Soft tissue protector) MS-2000
3.5 mm x 20 mm Cortical Screw CO-3200
Large Cannulated Quick
MS-3200
3.5 mm x 22 mm Cortical Screw CO-3220 Release Driver Handle
6 mm–70 mm Depth Gauge
3.5 mm x 40 mm Cortical Screw CO-3400 MS-9022
(2 mm increments)
3.5 mm x 45 mm Cortical Screw CO-3450 3.1 mm X 300 mm IM Rod Reamer RMT3130

3.5 mm x 50 mm Cortical Screw CO-3500 3.7 mm T-Handle Reamer RMT3730

3.5 mm x 55 mm Cortical Screw CO-3550 .062" x 6" Guide Wire WS-1607ST

3.5 mm x 60 mm Cortical Screw CO-3600 Fibula Rod System Tray Assembly 80-0114

3.5 mm x 65 mm Cortical Screw CO-3650

To learn more about the full line of Acumed® innovative

surgical solutions, please contact your local Acumed®
Sales Representative or call 888.627.9957.

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Notes:

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LEX00-01-F
Effective: 04/2014
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