Frail Ankle Fractures: Walking Sooner With Intramedullary Nailing

Hindfoot nailing gets frail, elderly ankle-fracture patients’ weight-bearing early without added complications, according to two retrospective studies. Long-term function remains unproven.

The clinical gap

These patients often can’t comply with non-weight-bearing instructions, ORIF is frequently unsafe for them, and casting also requires non-weight-bearing.

Study 1: 22 patients (mean age 79, all ASA 3 or higher) were nailed without joint preparation.



• All patients (100%) were fully weight-bearing from day one.

• Mean FAAM-ADL score in survivors was 33.8% (n=6).

• Complication rate was 14%, with no wound complications requiring surgery.

• One-year mortality was 32%, with no deaths related to the procedure.

Study 2: 130 patients aged 60+ were compared, 39 with tibiotalocalcaneal (TTC) nails versus 91 traditional constructs.

• Weight-bearing began at 1.6 weeks versus 9.8 (p < 0.001).

• Reoperation, implant failure, or deep infection rates did not differ.

• Home discharge rates were similar.

The catch

Function was scored in only six patients, so the long-term benefit is still unknown. Study 1’s 32% one-year mortality reflects the frailty of this population, not the procedure.