Geriatric Ankle Fractures: Fixation Affects Function

by Vince Vacketta, DPM

Geriatric ankle fractures carry high morbidity. Fixation choice influences early weight-bearing, mobilization, complication risk, and functional recovery – all critical in frail patients where prolonged immobility can be devastating.

Study overview

In a recent prospective multicenter study, researchers compared fibular nailing (FN) versus locking plate fixation (ORIF) in 55 elderly, medically complex patients with unstable ankle fractures across two trauma centers.

Major results

Early weight-bearing: FN outperformed ORIF

• Full weight-bearing at discharge: 62% FN versus 0% ORIF

• Better early-function scores at six weeks:

• AOFAS: FN > ORIF

• OMAS: FN > ORIF

Radiographic alignment: ORIF superior, but clinically irrelevant:

• FN showed higher malalignment rates

• This did not increase complication or reoperations

Long-term outcomes: equivalent at 12 months

• No significant functional differences between groups

• FN actually required few reoperations (26% FN versus 38% ORIF)

Bottom line

In geriatric patients, time matters! Fibular nailing may offer meaningful short-term advantages with early weight-bearing and return to function, though long-term outcomes equivalent to plating.