Summary The Phantom® Fibula Nail System is a purpose-built, intramedullary solution for distal fibula fixation that couples an expandable proximal fixation feature, a threaded distal peg cluster, and integrated targeting for rigid or dynamic syndesmotic stabilization. A radiolucent outrigger enables reduction maneuvers and precise placement of implants through the nail. A streamlined guide and reaming workflow helps optimize the correct start point and maintain central canal trajectory. Implant diameters and lengths cover a wide spectrum of patient anatomies. Design Implants & materials: Type II anodized titanium implants available in multiple diameters and lengths to accommodate varied fibular canals. Distal fixation & syndesmosis through the nail: Threaded distal locking holes accept Ø2.7 mm headless threaded pegs that interlock with the nail to secure the distal fragment and help resist backout or migration. Multiple syndesmotic options from the P28 portfolio include R3FLEX™, R3ACT™, or Ø3.5 mm static threaded pegs targeted through the nail at defined angles. Proximal fixation: Expandable proximal wings increase the nail’s effective diameter by ~1 mm per side (2 mm total) to mitigate rotation and potential fracture collapse. The wings can be retracted for removal. Guidance & reaming: Entry K-wire guide optimizes the start point and nail trajectory. Opening distal reamer contains notches for syndesmotic levels and hash marks for countersink depth. Solid and cannulated proximal reamers are available. Optional curved reamer guide centralizes the pilot and avoids eccentric reaming. Outrigger & reduction aids: Radiolucent outrigger with clearly labeled targeting windows. K-wire tip hole shows nail depth. Curved K-wire guides capture the fragment around the nail. Locking K-wire clamp sleeve holds tibial control for rotation or traction after insertion. End caps & removal: End caps (1, 5, 10, 20 mm) fine-tune distal position when the syndesmosis requires countersinking. Easy-Out and removal hook provided to facilitate efficient explantation. Indications Fixation of fibular fractures and osteotomies. Approach Positioning: Supine with ipsilateral bump Lateral decubitus Prone Internal rotation of the leg exposes the lateral fibula and enables AP imaging. Incision: 1.5–2 cm vertical incision centered over the distal fibular tip, extending slightly proximal and distal. Soft-tissue dissection exposes the distal fibula while protecting the peroneal tendons. Nail Size Offerings Fibular Nail Length Options x Fibular Nail Diameter Options Ø2.8 mm Ø3.4 mm Ø4.0 mm Ø5.5 mm 130 mm • • • • 180 mm • • • • 270 mm • • Ø2.8 mm x 130 mm Fibula Nail Ø5.5 mm x 180 mm Fibula Nail Ø3.4 mm x 270 mm Fibula Nail Distal and Proximal Locking 2.7 mm screws that interlock with the nail to secure the distal segment of the fibula with the nail Proximal wings expand nail diameter up to 1 mm on either side (2mm total) to prevent rotation and potential fracture collapse – may be retracted to accommodate removal Screws Phantom Fibula Nail P28 Syndesmotic Options 3.5mm Screw R3ACT Syndesmotic Screw R3FLEX Stabilization System