Nail fixation has higher complications compared to plate fixation for ankle injury in elderly

A new study published in The Bone and Joint Journal found that the functional result following nail and plate fixation was comparable, but the frequency of complications and further surgeries was much greater following nail fixation.

Results of the surgical therapy for an unstable ankle fracture in the elderly are positive. The gold standard is open reduction with plate osteosynthesis, however it can occasionally be challenging because to wound issues. Complication rates following open reduction and internal fixation of an ankle fracture range from 5% to 40% overall. In a recent meta-analysis, the prevalence of wound complications, both superficial and deep, was shown to be as high as 18.8%, particularly in patients with high-risk characteristics, such as the elderly, people with osteoarthritis, and those with diabetes.

This study was carried out by Ingrid Stake and colleagues to assess the functional, radiological, and complication rates following nail and plate fixation of unstable ankle fractures in older individuals.

120 patients with an acute unstable AO/OTA type 44-B ankle fracture who were older than ≥ 60 years old were randomly assigned to either a nail fixation or a plate fixation in this multicenter research. Patients were then monitored for 24 months following surgery. The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score served as the main outcome indicator. The EuroQol five-dimension questionnaire, the Manchester-Oxford Foot Questionnaire, the Olerud and Molander Ankle score, a visual analogue score for pain, complications, the quality of the fracture reduction, nonunion, and the onset of osteoarthritis were used as secondary outcome measures.

The key findings of this study were:

At 24 months, the median AOFAS score was the same in both groups (plate 95 (IQR 87 to 100), nail 90 (interquartile range (IQR) 82 to 100), p = 0.478). 

Following nail fixation, there were significantly higher problems and subsequent surgeries (p = 0.024 and p = 0.028, respectively) than following plate fixation. 

Other noteworthy variations between the two groups' results were nonexistent.

The authors suggested that the preferred therapy for older patients with unstable ankle fractures should typically be plate fixation. 

Reference: 

Stake, I. K., Ræder, B. W., Gregersen, M. G., Molund, M., Wang, J., Madsen, J. E., & Husebye, E. E. (2023). Higher complication rate after nail compared with plate fixation of ankle fractures in patients aged 60 years or older: a prospective, randomized controlled trial. In The Bone & Joint Journal (Vols. 105-B, Issue 1, pp. 72–81). British Editorial Society of Bone & Joint Surgery. https://doi.org/10.1302/0301-620x.105b1.bjj-2022-0595.r1