[Primary arthrodesis-Does it have advantages?]

Ankle fractures are the third most common fractures in old age with an incidence of up to 150/100,000 inhabitants per year. While anatomical joint reconstruction of the ankle using open reduction and internal fixation (ORIF) achieves good results in younger patients, geriatric patients are particularly prone to complications after surgery due to osteoporosis, multimorbidity and limited ability to maintain partial weight-bearing. Primary arthrodesis, usually performed as retrograde tibiotalocalcaneal (TTC) nailing, does not follow the anatomical reconstruction of the joint but pursues a different goal of a load-stable fixation that enables immediate full weight-bearing and thus avoids complications associated with immobilization. Studies have shown union rates of 85-100%, moderate functional results and a tendency towards fewer soft tissue complications compared to anatomical joint reconstruction. The indications are strictly selective and include nonreconstructable fractures, critical soft tissue situations, inability to bear partial weight and frail low-demand patients; however, the level of evidence is not high enough to derive recommendations. The currently available studies only have a retrospective study design, so that prospective randomized studies are required.