Abstract：
BACKGROUND: Tibiotalocalcaneal (TTC) nailing without joint preparation has been indicated as an alternative to open reduction and internal fixation (ORIF) in the treatment of unstable fragility ankle fractures. We hypothesized that primary hindfoot nailing without joint preparation, and immediate weight bearing can provide a safe and effective treatment for unstable fragility fractures of the ankle compared to ORIF.
METHODS: A retrospectively single-center cohort was reviewed for all surgically treated ankle fractures in patients aged 75 years and older between 2016 and 2021. The cases were grouped by the surgical technique: ORIF or TTC nailing. Diagnosis and treatment were validated by a review of the radiographs and the patients\' charts. Primary outcomes included complication rates and revision rates. The PROMs questionnaires included the Foot and Ankle-Ability Measure (FAAM-ADL) and the Olerud-Molander Ankle Score (OMAS).
RESULTS: Forty-six cases met the inclusion criteria during the study period. Eighteen in the TTC group and 28 in the ORIF group. The average follow-up was 46.4 months (Median 49.5, SD ± 25.3). The mean age of the TTC group was significantly higher (88.6 versus 81.8, p < 0.001). The mean surgery duration and length of stay were similar. The complication rates were 50.0 % in the ORIF group (28.6 % major) versus 22.2 % in the TTC group (5.6 % major), (p = 0.060). The revision rates were 28.6 % and 11.1 % in the ORIF and TTC groups respectively (p = 0.161). The FAAM-ADL was higher in the ORIF group (62.6 % versus 32.4 %, p = 0.020), as well as the OMAS (60.0 versus 32.8, p = 0.029).
CONCLUSIONS: TTC nailing without joint preparation for unstable fragility fractures of the ankle in the extremely elderly provided a better complication profile compared to traditional ORIF. However, PROMs were inferior.
METHODS: A retrospectively single-center cohort was reviewed for all surgically treated ankle fractures in patients aged 75 years and older between 2016 and 2021. The cases were grouped by the surgical technique: ORIF or TTC nailing. Diagnosis and treatment were validated by a review of the radiographs and the patients\' charts. Primary outcomes included complication rates and revision rates. The PROMs questionnaires included the Foot and Ankle-Ability Measure (FAAM-ADL) and the Olerud-Molander Ankle Score (OMAS).
RESULTS: Forty-six cases met the inclusion criteria during the study period. Eighteen in the TTC group and 28 in the ORIF group. The average follow-up was 46.4 months (Median 49.5, SD ± 25.3). The mean age of the TTC group was significantly higher (88.6 versus 81.8, p < 0.001). The mean surgery duration and length of stay were similar. The complication rates were 50.0 % in the ORIF group (28.6 % major) versus 22.2 % in the TTC group (5.6 % major), (p = 0.060). The revision rates were 28.6 % and 11.1 % in the ORIF and TTC groups respectively (p = 0.161). The FAAM-ADL was higher in the ORIF group (62.6 % versus 32.4 %, p = 0.020), as well as the OMAS (60.0 versus 32.8, p = 0.029).
CONCLUSIONS: TTC nailing without joint preparation for unstable fragility fractures of the ankle in the extremely elderly provided a better complication profile compared to traditional ORIF. However, PROMs were inferior.
摘要：
背景：没有关节准备的胫骨骨（TTC）钉已被证明是治疗不稳定脆性踝关节骨折的切开复位内固定（ORIF）的替代方法。我们假设没有关节准备的主要后脚钉，与ORIF相比，立即负重可以为踝关节不稳定脆性骨折提供安全有效的治疗。
方法：回顾性单中心队列研究了2016年至2021年间所有75岁及以上的手术治疗踝关节骨折患者。病例按手术技术进行分组：ORIF或TTC钉。诊断和治疗通过对X光片和患者图表的审查得到验证。主要结果包括并发症发生率和翻修率。PROM问卷包括脚和踝关节能力测量（FAAM-ADL）和Olerud-Molander踝关节评分（OMAS）。
结果：研究期间有46例符合纳入标准。TTC组18例，ORIF组28例。平均随访46.4个月(中位数49.5,SD±25.3)。TTC组的平均年龄明显较高(88.6对81.8,p<0.001)。平均手术时间和住院时间相似。ORIF组的并发症发生率为50.0%（主要为28.6%）与TTC组的22.2%（主要为5.6%），（p=0.060）。ORIF组和TTC组的修订率分别为28.6%和11.1%(p=0.161)。ORIF组的FAAM-ADL较高(62.6%对32.4%,p=0.020),以及OMAS(60.0对32.8，p=0.029)。
结论：与传统的ORIF相比，无关节准备的TTC钉治疗高龄踝关节不稳定脆性骨折的并发症情况更好。然而,PROMs较差。
方法：回顾性单中心队列研究了2016年至2021年间所有75岁及以上的手术治疗踝关节骨折患者。病例按手术技术进行分组：ORIF或TTC钉。诊断和治疗通过对X光片和患者图表的审查得到验证。主要结果包括并发症发生率和翻修率。PROM问卷包括脚和踝关节能力测量（FAAM-ADL）和Olerud-Molander踝关节评分（OMAS）。
结果：研究期间有46例符合纳入标准。TTC组18例，ORIF组28例。平均随访46.4个月(中位数49.5,SD±25.3)。TTC组的平均年龄明显较高(88.6对81.8,p<0.001)。平均手术时间和住院时间相似。ORIF组的并发症发生率为50.0%（主要为28.6%）与TTC组的22.2%（主要为5.6%），（p=0.060）。ORIF组和TTC组的修订率分别为28.6%和11.1%(p=0.161)。ORIF组的FAAM-ADL较高(62.6%对32.4%,p=0.020),以及OMAS(60.0对32.8，p=0.029)。
结论：与传统的ORIF相比，无关节准备的TTC钉治疗高龄踝关节不稳定脆性骨折的并发症情况更好。然而,PROMs较差。
