title: A prospective randomised controlled trial of the fibular nail versus standard open reduction and internal fixation for fixation of ankle fractures in elderly patients.
abstract: OBJECTIVE
  The fundamental concept of open reduction and internal fixation (ORIF) of ankle fractures has not changed appreciably since the 1960s and, whilst widely used, is associated with complications including wound dehiscence and infection, prominent hardware and failure. Closed reduction and intramedullary fixation (CRIF) using a fibular nail, wires or screws is biomechanically stronger, requires minimal incisions, and has low-profile hardware. We hypothesised that fibular nailing in the elderly would have similar functional outcomes to standard fixation, with a reduced rate of wound and hardware problems.
  
  
  METHODS
  A total of 100 patients (25 men, 75 women) over the age of 65 years with unstable ankle fractures were randomised to undergo standard ORIF or fibular nailing (11 men and 39 women in the ORIF group, 14 men and 36 women in the fibular nail group). The mean age was 74 years (65 to 93) and all patients had at least one medical comorbidity. Complications, patient related outcome measures and cost-effectiveness were assessed over 12 months.
  
  
  RESULTS
  Significantly fewer wound infections occurred in the fibular nail group (p = 0.002). At one year, there was no evidence of difference in mean functional scores (Olerud and Molander Scores 63; 30 to 85, versus 61; 10 to 35, p = 0.61) or scar satisfaction. The overall cost of treatment in the fibular nail group was £91 less than in the ORIF group despite the higher initial cost of the implant.
  
  
  CONCLUSIONS
  We conclude that the fibular nail allows accurate reduction and secure fixation of ankle fractures, with a significantly lower rate of soft-tissue complications, and is more cost-effective than ORIF. Cite this article: Bone Joint J 2016;98-B:1248-52.
authors: Edinburgh Orthopaedic Trauma Service, Royal Infirmary of Edinburgh, Little France, Edinburgh, EH16 4SU, UK.
authors: T O
authors: TO
authors: White
authors: Edinburgh Orthopaedic Trauma Service, Royal Infirmary of Edinburgh, Little France, Edinburgh, EH16 4SU, UK.
authors: K E
authors: KE
authors: Bugler
authors: Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA.
authors: P
authors: P
authors: Appleton
authors: Scottish Orthopaedic Research Trust, into Trauma (SORT-IT), Royal Infirmary of Edinburgh, Little France, EH16 4SU Scotland, UK.
authors: E
authors: E
authors: Will
authors: Edinburgh Orthopaedic Trauma Service, Royal Infirmary of Edinburgh, Little France, Edinburgh, EH16 4SU, UK.
authors: M M
authors: MM
authors: McQueen
authors: Edinburgh Orthopaedic Trauma Service, Royal Infirmary of Edinburgh, Little France, Edinburgh, EH16 4SU, UK.
authors: C M
authors: CM
authors: Court-Brown
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D064386:Ankle Fractures / Q000175:diagnosis / Q000601:surgery*; D001858:Bone Nails; D016009:Chi-Square Distribution; D005260:Female; D005360:Fibula / Q000601:surgery*; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation* / Q000379:methods; D017102:Fracture Healing / Q000502:physiology; D015577:Geriatric Assessment; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D011446:Prospective Studies; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome
keywords: Ankle; Fracture; Nail