Fibular nailing for bi-malleolar and tri-malleolar ankle fractures yields good functional outcomes - a retrospective single-centre study

INTRODUCTION: The surgical treatment of elderly patients with unstable ankle fractures is challenging. Open reduction and internal fixation with conventional plating technique often yields a poor outcome. However, fracture management with isolated fibular nailing represents an alternative method. METHODS: We performed a retrospective study of patients treated with isolated fibular nailing at the North Zealand Hospital, Denmark, between 1 January 2012 and 31 December 2016. A total of 58 patients were included. The primary outcome was post-operative function (dependency of a walking aid). Secondary outcomes were pain, radiographic union and complications (infection, fracture displacement and screw migration). RESULTS: At the last follow-up (mean follow-up of 10.3 months), 84.2% of the patients had returned to their baseline level of function. 18% had persistent pain. The last post-operative radiographic follow-up showed union in 93.7% of fractures of the lateral malleolus and 50% of the medial malleolus. The complication rate was 13.7%. CONCLUSIONS: Isolated fibular nailing with immediate full weight bearing in plaster yields an acceptable functional outcome in elderly patients with unstable fractures of the malleoli.