Fixation of ankle fragility fractures by tibiotalocalcaneal nail

Abstract

Given the low survivorship of this frail group of patients the main objectives are achieving early mobilisation whilst maintaining good fracture position. In our experience, tibiotalocalcaneal nailing is a very useful and successful way of treating fragility fractures of the ankle because it has a low risk of complications and restores function with impressive patient satisfaction. The potential benefits of this technique, we believe, outweigh the disability ensued from subtalar joint fusion.

Fragility fractures of the ankle in the frail elderly patient

“…10 Eliminating both subtalar and tibiotalar joint movement, does not appear to impair the overall function of these patients. After six months, most patients had regained their pre-operative functional levels, and as in previous reports [16][17][18] the Olerud and Molander scores did not fall substantially. This is perhaps a reflection of the fact that patients were selected for the procedure based on their low functional demand.…”

“…2,16,25 Although our patients were substantially older and had lower functional demands than those in other published series who had undergone internal fixation, 6-8 they were comparable to those in other reported groups treated with a calcaneotalotibial nail. [16][17][18] This reflected our selection criteria, as the procedure was only considered for patients who were physiologically frail and had a low functional demand. It is interesting to note that although 45 (94%) of our patients had low-energy injuries, the incidence of open fractures in our series was high (40%, 19 of 48) compared with other published series.…”

“…[16][17][18] These reports argue that this group of patients are physiologically comparable to those presenting with a fractured neck of the femur, in terms of having both multiple medical comorbidities and a high medium-term mortality of between 17% 16 and 46%. 17 These three small case series report no nonunion and a low rate of malunion (0% to 8%), [16][17][18] and that immediate partial 17 or unrestricted 16,18 weight-bearing was possible.…”

(iii) The osteoporotic ankle fracture

“…24 The second paper used a locked nail in 13 patients with a mean age of 79. 25 In neither study were the ankle or subtalar joints opened and there was no attempt 26 symptomatic and functional outcome scores, and good patient satisfaction was also reported. The option of nail removal after fracture union was offered in the expandable nail study but was only accepted by five patients.…”

Stabilization of Ankle Fragility Fractures with a Transtibiocalcaneal Fusion Nail

“…However, for most of the unstable ankle fractures in the elderly cast immobilization without weight-bearing is recommended after internal fixation. Therefore the decision-making process for treatment of ankle fractures in the elderly is challenging [2,9,12,14,18]. Adams (1948) described a case of pseudarthrosis after attempt fusion, which healed after reoperation with a flanged, retrograde intramedullary nail [1].…”