ICYMI: A New Treatment For Open Ankle Fractures (Which Act More Like Hip Fractures) in Older Patients

This debate — and the recommendation that seems to be arising from it — surprised us, and we think it will be helpful to you

Editor’s Note: A version of this post was sent to our Foot & Ankle subscribers. We thought this one too important for anyone who takes care of older patients with tough ankle fractures to miss. — SSL

What’s the Claim?

A case series reported on 34 older patients (ages 73 to 99) who were treated with a long tibiotalocalcaneal (TTC) nail — think pantalar fusion but without joint preparation for arthrodesis — and primary wound closure for open ankle fractures.

  • 56% of these patients worsened in terms of their mobility status
  • Nearly 80% were discharged somewhere other than home after the hospital stay
  • 6% of the patients died within 3 months

Those numbers sound more like hip fracture numbers than ankle fracture numbers — all the more so, considering that the authors don’t report a minimum follow-up duration and don’t say how many patients were lost to follow-up before some reasonable minimum period.

Despite all that, the authors concluded: “Use of a tibiotalocalcaneal nail with primary wound closure offers a reasonable treatment option for open fractures of the ankle in the elderly patient.”

  • What could justify such a viewpoint?

How’s It Stack Up?