[Soft tissue protecting operative treatment of complex ankle fractures in elderly patients using fibular nailing]

The incidence of ankle fractures in older patients shows a clear upward trend. However, their proper treatment is often challenging and may be associated with a high complication rate. The primary reasons for the increased complication rate can be attributed to the specific characteristics of the patient population, such as frequently complex morbidities, weakened bone structure, and less than optimal soft tissue conditions. These problems are more likely to arise with standard invasive operative methods, such as plate osteosynthesis, which can have a pronounced negative impact on the already sensitive soft tissues. To reduce complications associated with the treatment of multiple, complex ankle fractures in geriatric patients, a soft tissue-protecting alternative may be the intramedullary nailing of the distal fibula. In this case presentation, we aim to demonstrate the advantages of the anatomical intramedullary fibula nailing method using the examples of complex ankle fracture therapy in an 86-year-old and a 74-year-old patient. This technique offers anatomical fixation while ensuring significant soft tissue protection. It allows for (partial) weight-bearing after surgery, thereby facilitating the early mobilization of patients. With appropriate indications, this method can yield particularly good results in the operative treatment of ankle fractures in geriatric patients. Orv Hetil. 2025; 166(10): 392–397.