Department of Orthopaedics and Trauma Surgery, Klinik Gut, St. Moritz, Switzerland
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AO Research Institute Davos, Davos Switzerland
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) transsyndesmotic fibula fracture with a medial malleolar fracture after closed reduction of the distal fibula and stabilization with a retrograde fibular nail and open reduction of the medial fracture and stabilization with a compression screw and a K
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Introduction
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Fragility ankle fractures are traditionally managed conservatively or with open reduction internal fixation. Tibiotalocalcaneal (TTC) nailing is an alternative option for the geriatric patient. This meta-analysis provides the most detailed analysis of TTC nailing for fragility ankle fractures.
Methods
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A systematic search was performed on MEDLINE, EMBASE, Cochrane Library, and Web of Science, identifying 14 studies for inclusion. Studies including patients with a fragility ankle fracture, defined according to NICE guidelines as a low-energy fracture obtained following a fall from standing height or less, that were treated with TTC nail were included. Patients with a previous fracture of the ipsilateral limb, fibular nails, and pathological fractures were excluded. This review was registered in PROSPERO (ID: CRD42021258893).
Results
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A total of 312 ankle fractures were included. The mean age was 77.3 years old. In this study, 26.9% were male, and 41.9% were diabetics. The pooled proportion of superficial infection was 10% (95% CI: 0.06–0.16), deep infection 8% (95% CI: 0.06–0.11), implant failure 11% (95% CI: 0.07–0.15), malunion 11% (95% CI: 0.06–0.18), and all-cause mortality 27% (95% CI: 0.20–0.34). The pooled mean post-operative Olerud–Molander ankle score was 54.07 (95% CI: 48.98–59.16). Egger’s test (P = 0.56) showed no significant publication bias.
Conclusion
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TTC nailing is an adequate alternative option for fragility ankle fractures. However, current evidence includes mainly case series with inconsistent post-operative rehabilitation protocols. Prospective randomised control trials with long follow-up times and large cohort sizes are needed to guide the use of TTC nailing for ankle fractures.
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Department of Traumatology and Reconstructive Surgery including Department of Orthopedic Surgery, Charite Universitätsmedizin Berlin, Berlin, Germany
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contrast to open surgical fixation of distal fibular fractures, a percutaneous method was developed to minimize soft tissue stress while providing a reliable fixation method. Biomechanically, an intramedullary fibular nail provides a robust construct
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comparison study of a modern fibular nail and distal fibular locking plate in AO/OTA 44C2 ankle fractures . Journal of Orthopaedic Surgery and Research 2016 11 100. ( https://doi.org/10.1186/s13018-016-0435-5 ) 35. Dingemans SA Lodeizen OAP Goslings
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patients with vulnerable skin conditions, an intramedullary fibular nail may be used to minimise soft tissue compromise. 36 Another simple option to enhance fixation of the distal fibula is the use of a hook plate. 2 , 37 Cement augmentation
