Trial reportEuropean journal of trauma and emergency surgery : official publication of the European Trauma Society2026
Fixing geriatric ankle fractures: fibular nail versus locking plate in a prospective multicenter study.
Trial report in European journal of trauma and emergency surgery : official publication of the European Trauma Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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8 authors.
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Abstract
purposeElderly patients with unstable ankle fractures face a high risk of wound and implant-related complications after open reduction and internal fixation (ORIF). Less invasive intramedullary fibular nail (FN) fixation may reduce soft-tissue trauma and enable earlier mobilization.
methodsIn this prospective multicenter trial with pseudorandomized allocation and protocol-permitted crossover, 55 geriatric multimorbid patients (Charlson Comorbidity Index ≥ 4; mean age FN 79 ± 8 vs. ORIF 74 ± 8 years; p = 0.053) were treated with FN (n = 39) or ORIF (n = 16). Primary outcomes were operative time, fluoroscopy time, hospital stay, weight-bearing at discharge, complications, and functional scores (AOFAS, OMAS, Weber) at six weeks and twelve months.
resultsFN required more fluoroscopy time (p = 0.011), while operative duration and hospital stay were comparable (p = 0.176, p = 0.520). Full weight-bearing at discharge was more frequent after FN (62% vs. 0%; p < 0.001). At six weeks, FN patients achieved higher functional scores (AOFAS p = 0.041; OMAS p = 0.027), but at twelve months no differences remained (AOFAS p = 0.404; OMAS p = 0.288; Weber p = 0.585). Radiographic malalignment was more common after FN (46% vs. 13%; p = 0.031). Distal screw loosening at twelve months occurred more often after FN (80% vs. 11%; p = 0.005) but was mostly asymptomatic.
conclusionEarlier mobilization observed after FN in our study primarily reflects the permissive postoperative weight-bearing protocol rather than an inherent biomechanical advantage of the implant. At twelve months, functional outcomes were equivalent, underscoring that protocol-driven early loading, not implant design, explains early differences.
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