Ankle Fractures That Act Like Hip Fractures, and a New Treatment for Them

The unusual debate about tibiotalocalcaneal nails for ankle fractures in older patients

What’s the Claim?

Since you may hear from thought leaders in the world of foot and ankle trauma on the topic we're covering here this week, this post will be about a debate as much as an article. Their recommendation may turn out to be right, but we want you to have a clear sense of what we know on this topic.

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

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’ conclusion was: “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?