Long hindfoot nail fixation using standard tibial nails for elderly ankle and distal tibia fractures

IF 2 3区医学 Q3 CRITICAL CARE MEDICINE

Injury-International Journal of the Care of the Injured Pub Date : 2025-08-05 DOI:10.1016/j.injury.2025.112648

Mr Ghiath Ismayl , Miss Sadia Afzal , Mr Majed Al Najjar , Mr Mohamed Said Ammar , Mr Aiman Khunda , Mr Dominic Sprott , Mr Asan Rafee , Mr Peyman Bakhshayesh , Mr Patrick Foster

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引用次数: 0

Abstract

Introduction

Fragility ankle and distal tibia fractures in the elderly population present a complex clinical situation, due to the poor bone quality, soft tissue condition and medical comorbidities in this age group. This study aims to assess the outcome of long hindfoot nail fixation using standard tibial nails in managing these injuries. This is the largest and possibly first study to date of this implant used in ankle trauma hindfoot fixation.

Methods

This was a retrospective observational study across two level 1 major trauma centres in the United Kingdom, from January 2019 to December 2024. Patients included were above the age of 60 years, with acute ankle or distal tibia fractures and underwent long hindfoot nail fixation with standard tibial nails. Postoperative complications, early weightbearing and mortality rates were assessed.

Results

A total of 36 patients were included, of which 44.4 % were malleolar fractures, 38.9 % distal tibia extra-articular fractures, and 16.7 % distal tibia intra-articular fractures. Half of the cases were open fractures. There were no cases of periprosthetic fracture, re-fracture, fixation or implant failure. There were six (16.7 %) postoperative complication cases, of which only one (2.8 %) was deemed a major complication; re-operation for removal of proximal locking bolt due to infection. 88.9 % were able to full weightbear within 30 days after surgery. The mortality rate was 8.3 % at 30 days and 16.7 % at 1 year.

Conclusion

The use of standard tibial nails, a universally available and feasible implant, for long hindfoot nail fixation in fragility ankle and distal tibia fractures is a safe and reliable treatment option, with a success rate of 97.2 % without major complications. They permit early weightbearing and provide a stable construct with reduced risk of periprosthetic fractures and fixation failure. The mortality rate was comparable to fragility hip fractures, highlighting the medical complexity of patients with these injuries.

查看原文本刊更多论文

标准胫骨长后足钉固定治疗老年踝关节及胫骨远端骨折

老年人群脆性踝关节骨折和胫骨远端骨折的临床情况比较复杂，主要是由于老年人群骨质、软组织状况较差以及医学合共病所致。本研究的目的是评估使用标准胫骨钉治疗这些损伤的后脚长钉固定的结果。这是迄今为止该植入物用于踝关节创伤后足固定的最大研究，可能也是第一次。方法：这是一项回顾性观察研究，从2019年1月到2024年12月，在英国的两个一级主要创伤中心进行。纳入的患者年龄在60岁以上，急性踝关节或胫骨远端骨折，采用标准胫骨钉进行后脚长钉固定。评估术后并发症、早期负重和死亡率。结果共纳入36例患者，其中踝部骨折占44.4%，胫骨远端关节外骨折占38.9%，胫骨远端关节内骨折占16.7%。半数病例为开放性骨折。无假体周围骨折、再骨折、固定或假体失败病例。术后并发症6例（16.7%），其中主要并发症1例（2.8%）；因感染再次手术取出近端锁栓。88.9%的人能够在手术后30天内完全负重。30天死亡率为8.3%，1年死亡率为16.7%。结论使用标准胫骨钉固定后足长钉治疗脆性踝关节骨折和胫骨远端骨折是一种安全可靠的治疗方法，成功率为97.2%，无重大并发症。它们允许早期负重，提供稳定的结构，降低假体周围骨折和固定失败的风险。死亡率与脆性髋部骨折相当，突出了这些损伤患者的医疗复杂性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Injury-International Journal of the Care of the Injured 医学-急救医学

CiteScore

4.00

自引率

8.00%

发文量

699

审稿时长

96 days

期刊介绍： Injury was founded in 1969 and is an international journal dealing with all aspects of trauma care and accident surgery. Our primary aim is to facilitate the exchange of ideas, techniques and information among all members of the trauma team.