Tibiotalocalcaneal nailing may be safe for unstable fragility ankle fractures
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Key takeaways:
- Higher rates of complications and reoperations with open reduction and internal fixation were not statistically significant.
- Differences in patient-reported outcomes favored open reduction and internal fixation.
LAS VEGAS — Tibiotalocalcaneal nailing may be a safe alternative to open reduction and internal fixation for treatment of unstable fragility ankle fractures, according to results presented here.
“However, inferior patient-reported outcomes compared to traditional [open reduction and internal fixation] ORIF can be expected,” Dan Prat, MD, said in his presentation at the American Academy of Orthopaedic Surgeons Annual Meeting.
Prat and colleagues retrospectively categorized 46 patients aged 75 years and older with an ankle fracture into groups based on whether they were treated with tibiotalocalcaneal nailing (n=18; T2 Hindfoot Nail, Stryker) or ORIF with stainless steel anatomic ankle locking plates and screws (n=28; Arthrex) between 2016 and 2021. Prat noted patients who underwent tibiotalocalcaneal nailing did not undergo joint preparation or postoperative splinting and had immediate weight-bearing after surgery, while patients who underwent ORIF had a postoperative splint and were non-weight-bearing for 2 to 6 weeks postoperatively.
“The primary outcomes were the rates of complications and reoperations,” Prat said. “We used two validated patient-reported outcome questionnaires, the foot and ankle mobility measure and the Olerud-Molander Ankle Score.”
Prat noted patients in the tibiotalocalcaneal group were significantly older, all were female, had worse baseline characteristics and worse preoperative ambulatory status. He added both groups had similar rates of diabetes and fracture patterns, as well as no cases of neuropathy.
“Surgery duration was similar, on average, as well as the length of stay,” Prat said.
Although patients in the ORIF group had higher rates of complications and reoperations, Prat noted the difference was not statistically significant.
“Similar to preoperatively, the postoperative ambulation status was significantly better in the ORIF group,” Prat said. “We also found significant differences in patient-reported outcomes in favor of ORIF in both of the questionnaires.”
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Prat D, et al. Paper 529. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting. March 7-11, 2023; Las Vegas.
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