S3.E33 - Are Fibular Nails Superior to Plating Ankle Fractures? with Dr. Calvin Rushing

Dr. Calvin Rushing joins Dr. Jeff Dikis for a hard-hitting conversation on unstable ankle fractures, syndesmotic alignment, and why the newest generation of intramedullary fibular nails may finally solve some of the biggest pitfalls of older techniques.

Rushing breaks down what went wrong with early cases, and how newer straight or semi-flexible designs changed his thinking. He also explains the center-center technique for syndesmotic fixation, why rotation of the nail matters more than most surgeons realize, and how a simple AP view can hide a malreduction that a lateral x-ray or CT scan makes impossible to ignore.

Dr. Rushing also shares the practical realities that drive the debate: noncompliance, high-BMI patients, revision surgery, delayed wound healing, and the very real tradeoffs between easier plating and the long-term benefits of evolving toward minimally invasive fixation.

Jeff and Calvin also revisit vancomycin powder, sustained-release carriers, and the broader push to make infection prevention actually last beyond the first few hours after surgery.

If you fix ankle fractures, manage syndesmotic injuries, or want a clearer framework for when to plate, when to nail, and how to avoid creating a bigger problem than the one you started with, this episode is essential listening.