SLR - October 2023 - Choudhury
Title: Hindfoot nailing for displaced ankle fractures in the elderly: A case-control analysisReference: Ou C, Baker JF. Hindfoot nailing for displaced ankle fractures in the elderly: A case-control analysis. Injury. 2023 Aug;54(8):110921. doi: 10.1016/j.injury.2023.110921. Epub 2023 Jun 29. PMID: 37451032.
Level of Evidence: Retrospective case-control
Scientific Literature Review
Reviewed By: Shakib Choudhury, DPM
Residency Program: Montefiore Medical Center, Bronx, NY
Podiatric Relevance:
Interested at different surgical techniques on displaced ankle fractures via hindfoot nailing vs classic ORIF
Evaluate integrity of alternative TTC or hindfoot nail vs classic open reduction and internal fixation with screw and plate construct for displaced ankle fractures in the elderly population.
Methods:
• Retrospective case control study from level 1 trauma center looking at patients who underwent surgery (hindfoot nailing vs ORIF were matched with age, gender and comorbidities) for unstable ankle fractures from 1/1/2010 to 12/31/2021. Total of 504 patients were surgically treated for an ankle fracture, inclusion criteria for this study were at least 65 years old, unstable ankle fracture (uni, bi, tri malleolar patterns) and low energy trauma causing fracture. Exclusion criteria were pathological fractures and polytrauma setting.
• Outcomes included mortality, operation time, return to activities of daily living, hardware failure, hardware infections, wound complications
Results:
• Narrowed down to 26 patients in hindfoot (H) group vs 26 patients in ORIF (O) group, average age 84 (H), 83 (O), 12 complications (H), 11 complications (O), 7 return to OR (H), 2 return to OR (O), average 22 days for weightbearing (H), average 59 days for weightbearing (O), no statistically significant differences in length of stay and operation time between (H) and (O) groups
Conclusions:
Assumed ankle open reduction and internal fixation was the only option for treating displaced ankle fractures. Despite patients being able to weight bear earlier in the hindfoot group vs ORIF group, the clinician should consider the complications and return to OR increased risk associated in the hindfoot group.
The clinician should know the patient, their compliance and their goals/expectations and proceed accordingly in proper treatment of diagnosed ankle fractures. Would re-evaluate frail and elderly patients with displaced ankle fractures more closely to determine their goals to maximize return to activities of daily living post operatively.