Primary Retrograde Tibiotalocalcaneal Nailing For Fragility Ankle Fractures

Area of Science:

• Orthopedic Surgery
• Trauma Care
• Bone Fracture Management

Background:

• Ankle fragility fractures present treatment challenges due to poor bone quality, soft tissue issues, and common comorbidities like diabetes and neuropathy.
• Conventional open reduction and internal fixation (ORIF) for these fractures often result in high complication rates.
• There is a need for effective fixation techniques in high-risk patients with ankle fragility fractures.

Purpose of the Study:

• To critically evaluate the efficacy of acute hindfoot nailing as a percutaneous fixation technique for high-risk ankle fragility fractures.
• To assess the complication rates and union rates associated with retrograde tibiotalocalcaneal nailing.
• To compare hindfoot nailing with conventional ORIF methods.

Main Methods:

• A retrospective review of 31 patients treated with primary retrograde tibiotalocalcaneal nail without joint preparation.
• Data collected from an urban Level I trauma center between 2006-2012.
• Postoperative follow-up averaged 13.6 months.

Main Results:

• Achieved radiographic union in 90.3% of patients at an average of 22.2 weeks, maintaining foot and ankle alignment.
• Reported superficial infections in 6.5% and deep infections in 9.7% of cases.
• Observed three cases of asymptomatic screw breakage, all managed conservatively.

Conclusions:

• Retrograde hindfoot nailing is an acceptable treatment for ankle fragility fractures, particularly in high-risk populations.
• Advantages include early weightbearing, minimal soft tissue injury, and a lower complication profile compared to ORIF.
• Further prospective randomized trials are warranted to compare hindfoot nailing with conventional ORIF.