Fibular nails versus hindfoot nails in the management of ankle fractures with soft tissue injury in the elderly – a preliminary study

Introduction Fragility ankle fractures are becoming increasingly common with an ageing population. Underlying co-morbidities, osteoporosis and a poor soft tissue envelope makes their management challenging. Purpose The aim of this study was to compare the results of fibular nail (FN) versus hindfoot nail (HFN) for the treatment of fragility ankle fractures. Patients and Methods This was a retrospective comparative study from a level 1 trauma centre. All patients over the age of 60 with a low energy fragility ankle fracture between January 2017 and February 2021 were included in the study. Primary outcome was Olerud-Molander ankle score. Secondary outcomes were postoperative complications and re-operation rates. Mean follow-up was 6.2 months. Results Fifty six patients were identified with a mean age of 74 years. Time to radiographic union rate was not significantly different between both groups (p = 0.626). No cases of non-union or malunion were identified. The mean Olerud-Molander ankle score was significantly higher in FN group (p < 0.01). There was a higher wound complication rate in the HFN group (p = 0.04). The incidence of reoperation did not significantly differ between both groups (p = 0.118). Conclusion Hindfoot nails and fibular nails can lead to equivalent union rates. However, better functional outcomes and reduced complication rate are observed after fibular nails.