Treatment of fragility ankle fractures using hindfoot nail, systemic review

Elmajee, Mohammed; Abdullah, Gabr; Aljawadi, Ahmed; Strang, Matthew; Khan, Shoaib; Munuswamy, Sivashankaren; Pillai, Anand; Dominic, Sprott

doi:10.1016/j.jor.2020.11.006

Cited by 10 publications

(5 citation statements)

References 22 publications

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“…This case series demonstrates that hindfoot nails are an effective tool to treat ankle and distal tibia fractures in geriatric patients who have multiple medical comorbidities and are consequently at increased risk for perioperative complications. 3 , 6 Of the 22 patients treated with HFN, the majority were indicated for acute closed bi- and trimalleolar fractures of the ankle. This finding is consistent with other literature demonstrating that in geriatric patients, unstable ankle fractures are the typical indication for surgical reduction and fixation with a hindfoot nail.…”

Section: Discussionmentioning

confidence: 99%

“…Lastly, in concordance with other similar studies, 13.6% of our patients experienced complications within 30 days post-surgery. 3 Elmajee et al 3 reported that based on a systematic review comprised of 7 studies, with 194 patients undergoing HFN, the overall complication rate was 16.5%, of which the most common adverse events were nail or screw breakage, return to the OR, and infection. Consistent with these results, infection requiring antibiotics, without operative intervention, was the most common complication in our series.…”

Section: Discussionmentioning

confidence: 99%

“… 2 Though it does delay return to weight bearing by up to 12 weeks, ORIF allows many patients to achieve near-baseline levels of activity, while limiting the development of posttraumatic osteoarthritis. 3 – 5 Still, this injury can have a devastating impact on senior patients, as it limits their ability to independently perform activities of daily living and has been associated with 1-year mortality rates as high as 12%. 1 Some of the morbidity and mortality may be due to prescribed, prolonged non-weight-bearing to the affected limb after ORIF.…”

Section: Introductionmentioning

confidence: 99%

“…Given the lack of consensus within the orthopaedic surgery community on when and in which patients to use HFN for definitive fixation of ankle and distal tibia fractures, each study contributes much-needed evidence to the question at hand. 3 Through this case series, we aim to determine whether hindfoot nails without open subtalar and tibiotalar joint preparation reliably achieve favorable outcomes, with minimal complications, in geriatric patients who have suffered an ankle malleolar or distal tibia fracture.…”

Section: Introductionmentioning

confidence: 99%

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Use of a Hindfoot Nail Without Separate Subtalar and Tibiotalar Joint Preparation to Treat Geriatric Ankle and Distal Tibia Fractures: A Case Series

Duvvuri,

Trout,

Bub

et al. 2023

Geriatr Orthop Surg Rehabil

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Introduction Ankle fractures in geriatric patients can be devastating injuries, as they limit an individual’s mobility, autonomy, and quality of life. This study examines the functional outcomes and complications related to hindfoot nails (HFN) in geriatric patients who have suffered an ankle malleolar or distal tibia fracture. Materials and Methods This is a single-surgeon case-series of patients who underwent HFN for acute fixation or delayed reconstruction after an ankle or distal tibia fracture. Demographic information, comorbidities, baseline functional status, AO/OTA classification, surgical indications, need for external fixation, total operative time, length of stay (LOS), ambulation at discharge, and discharge disposition were recorded. Primary outcomes included 30-day complications, ambulation at follow-up, and time to fracture union and fusion. Results There were 22 patients, with average age 80.8 years. Mean LOS was 7.0 days, and 68.2% were discharged to subacute rehabilitation. Within 30 days, 1 patient developed a deep vein thrombosis and bilateral pulmonary emboli, and 2 experienced wound dehiscence requiring antibiotics. At 6-weeks, 1 patient sustained a fall with periprosthetic fracture requiring HFN revision, and another developed cellulitis necessitating hardware removal. Fracture healing was seen in 72.7% at 19.4 weeks, while radiographic fusion occurred in 18.2% at 43.0 weeks. 72.7% were ambulating with an assistive device at discharge, and 100.0% at 12-weeks post-operatively or last follow-up. Upon final examination, all patients were ambulating without pain. Discussion HFNs provide a reliable alternative to traditional open reduction internal fixation and have the ability to improve quality of life for geriatric patients through a faster return to weight-bearing. Additionally, radiographic fusion rates show that patients have favorable functional outcomes even without formal arthrodesis. Conclusion HFN is beneficial for elderly patients with low functional demand and complex medical comorbidities, as it allows for early mobility after sustaining an ankle or distal tibia fracture.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Use of a Hindfoot Nail Without Separate Subtalar and Tibiotalar Joint Preparation to Treat Geriatric Ankle and Distal Tibia Fractures: A Case Series

Duvvuri,

Trout,

Bub

et al. 2023

Geriatr Orthop Surg Rehabil

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“…Especially in cases with severe soft tissue damage around the planned approach for standard implants or in low-demand geriatric patients, the use of a hindfoot nail to treat ankle fractures should be considered ( 64 , 84 ). Studies show favorable outcomes regarding early rehabilitation, restoration of function and length of hospital stay ( 85 , 86 ). Even in cases of non-union of the fracture, patients showed satisfying postoperative results as the nail, which can be left in place, will continue to stabilize the ankle.…”

Section: Primary Retrograde Nail Arthrodesismentioning

confidence: 99%

Ankle fractures of the geriatric patient: a narrative review

et al. 2023

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The present narrative review provides a summary of current concepts for the treatment of ankle fractures in elderly patients. Despite a high complication rate, open reduction and internal fixation is the gold standard for operative care. However, individual patient-based treatment decision considering the soft-tissue status, the fracture pattern, as well as the patient’s mobility and comorbidities is mandatory to achieve sufficient patient outcomes. Due to high complication rates after surgery in the past, techniques such as fibular nails or minimal invasive techniques should be considered.

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