Higher complication rate after nail compared with plate fixation of ankle fractures in patients aged 60 years or older: a prospective, randomized controlled trial

Author:

Stake Ingrid K.12ORCID,Ræder Benedikte W.3ORCID,Gregersen Martin G.4,Molund Marius1ORCID,Wang Johan5,Madsen Jan E.26ORCID,Husebye Elisabeth E.6ORCID

Affiliation:

1. Department of Orthopaedic Surgery, Østfold Hospital Trust, Grålum, Norway

2. Institute of Clinical Medicine, University of Oslo, Oslo, Norway

3. Department of Orthopaedic Surgery, Bærum Hospital, Vestre Viken Hospital Trust, Gjettum, Norway

4. Department of Physical Medicine and Rehabilitation, Østfold Hospital Trust, Grålum, Norway

5. Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway

6. Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway

Abstract

Aims The aim of this study was to compare the functional and radiological outcomes and the complication rate after nail and plate fixation of unstable fractures of the ankle in elderly patients. Methods In this multicentre study, 120 patients aged ≥ 60 years with an acute unstable AO/OTA type 44-B fracture of the ankle were randomized to fixation with either a nail or a plate and followed for 24 months after surgery. The primary outcome measure was the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score. Secondary outcome measures were the Manchester-Oxford Foot Questionnaire, the Olerud and Molander Ankle score, the EuroQol five-dimension questionnaire, a visual analogue score for pain, complications, the quality of reduction of the fracture, nonunion, and the development of osteoarthritis. Results At 24 months, the median AOFAS score was equivalent in the two groups (nail 90 (interquartile range (IQR) 82 to 100), plate 95 (IQR 87 to 100), p = 0.478). There were statistically more complications and secondary operations after nail than plate fixation (p = 0.024 and p = 0.028, respectively). There were no other significant differences in the outcomes between the two groups. Conclusion The functional outcome after nail and plate fixation was equivalent; however, the complication rate and number of secondary operations was significantly higher after nail fixation. These results suggest that plate fixation should usually be the treatment of choice for unstable ankle fractures in the elderly. Cite this article: Bone Joint J 2023;105-B(1):72–81.

Publisher

British Editorial Society of Bone & Joint Surgery

Subject

Orthopedics and Sports Medicine,Surgery

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