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Evaluating Fibular Intramedullary Nails vs Traditional Plating in Geriatric Ankle Fractures: A 12-Year Single-Center
Yiyun Lin1, Jie Gao1, Huayong Zheng1
1Department of Orthopedic Surgery, Senior Department of Orthopedics, the Seventh Medical Center of PLA General Hospital, Beijing, China.
Foot & Ankle International
|May 9, 2024
Summary
Fibular intramedullary nails (IMNs) offer comparable functional outcomes to plates and screws (PS) for elderly ankle fracture patients, with significantly fewer complications. However, IMNs showed inferior mortise alignment quality compared to PS.
Area of Science:
- Orthopedic Surgery
- Trauma Surgery
- Geriatric Orthopedics
Background:
- Unstable ankle fractures are common in elderly patients (≥65 years).
- Surgical treatment options include fibular intramedullary nails (IMNs) and traditional plates and screws (PS).
- Comparative outcome data for these methods in the elderly population is limited.
Purpose of the Study:
- To compare the outcomes of IMNs versus PS for treating unstable ankle fractures in elderly patients.
- To evaluate complications, reduction quality, union rates, and functional scores.
- To inform optimal treatment strategies for this demographic.
Main Methods:
- Retrospective study of 32 elderly patients treated with IMNs (2010-2022).
- Comparison with 125 case-control patients treated with PS.
- Outcomes assessed: complications, reduction, union, implant removal, Olerud Molander Ankle Score (OMAS) at ≥2-year follow-up.
Main Results:
- IMN group had more high-energy injuries and concomitant procedures.
- IMN group showed significantly lower wound-related (3.1% vs 20%) and non-wound-related complications (18.8% vs 39.2%).
- Mortise alignment quality was inferior in the IMN group (53.1% good vs 79.2% in PS group).
- Functional outcomes (OMAS), union rates, and weightbearing timelines were similar between groups.
Conclusions:
- Fibular IMNs provide comparable functional outcomes to PS in elderly patients with ankle fractures.
- IMNs are associated with a lower complication rate compared to PS.
- PS achieved superior mortise reduction quality, necessitating further research into optimizing IMN techniques for elderly patients.
