Distal Femoral Nail as a Cost-Effective Alternative to Tibiotalocalcaneal Nail for Ankle Fracture Non-Union in an Elderly Patient: A Case Report.

Introduction: Ankle fracture non-union in elderly patients is challenging due to osteoporotic bone, comorbidities, and risks associated with open reduction and internal fixation (ORIF). Tibiotalocalcaneal (TTC) nail fixation enables early weight-bearing but is costly and not widely available in resource-limited settings.

Case report: We present an 83-year-old male with a painful, deformed left ankle and non-union of a bimalleolar fracture treated conservatively. Comorbidities included diabetes mellitus and hypertension. Due to fragile skin and high ORIF-associated risks, a distal femoral nail (DFN) was used as a substitute for a TTC nail. A minimally invasive technique was performed, including joint preparation and medial malleolar bone grafting. Weight-bearing was initiated postoperatively.

Conclusion: DFN offered comparable fixation with reduced cost and acceptable complications. This case highlights DFN's utility as a TTC nail substitute in elderly patients, ensuring stability, early mobilization, and functional recovery in low-resource settings.