Percutaneous Tibiotalocalcaneal Nailing in Fragility Ankle Fractures of the Elderly: A Single-Center Case Series

Fragility ankle fractures in elderly patients are associated with high rates of wound complications, fixation failure, and prolonged loss of mobility. For individuals with significant osteopenia or compromised soft tissues, conventional open reduction and internal fixation may be unsuitable. Retrograde tibiotalocalcaneal (TTC) nailing provides a minimally invasive, load-sharing construct that facilitates early weight-bearing. This study reports outcomes from a retrospective single-center case series evaluating percutaneous TTC nailing in elderly patients with unstable fragility ankle fractures.

A retrospective review was performed on all consecutive patients aged ≥65 years who underwent percutaneous TTC nailing at a UK trauma unit between February 2007 and February 2008. Demographic data, fracture classification, complications, radiographic union, Olerud-Molander Ankle Score (OMAS), mobility status, and mortality were recorded. Radiographic union was defined as bridging callus across ≥3 cortices.

Twenty-three patients (mean age 89 years; 22 female) were included. Arbeitsgemeinschaft für Osteosynthesefragen (AO) fracture types included 44-B2 (n=10), 44-B3 (n=9), 44-C2 (n=2), 43-A1 (n=1), and 43-A3 (n=1). The median hospital stay was nine days. Two superficial infections occurred; no deep infections, thromboembolic events, or implant failures were recorded. Most surviving patients demonstrated radiographic union by 12 weeks. The mean OMAS was 49.7±8.5. Thirty-day and one-year mortality rates were 21.7% and 43.5%, respectively.

This study reports descriptive outcomes of a small retrospective case series and does not allow causal inference or comparison with alternative treatments. Within these limitations, percutaneous TTC nailing provided stable fixation with low observed wound-related complications in this frail, elderly cohort. The findings should be interpreted cautiously, and prospective comparative studies are required.