Objective: To critically appraise the use of hindfoot nailing as an alternative treatment for fragility fractures of the ankle.

Summary of background data: Ankle fractures are common. The peak incidence now lies in women between the ages of 75 and 84. These fractures are inherently unstable and it is known that anatomical reduction and stable fixation leads to a rapid return of function. Although this is usually achieved by open reduction and plate and screw fixation, in older patients poor bone quality and compromised wound healing can lead to unacceptably high complication rates. Conservative management of these patients also has its problems with anatomical congruity being difficult to achieve and maintain.

Method: We reviewed 13 patients who underwent minimally invasive intramedullary nailing to fuse the tibiotalocalcaneal joint as primary or revision treatment for an ankle fracture. Olerud and Molander Scale, and SF36 were used as outcome measures.

Results: There were 12 females and 1 male with a mean age of 81.5 (range 64 to 93). One nail was revised after 22 days due to valgus deformity and one patient suffered a minor wound (breakdown / infection). Half of the patients were discharged in the first two weeks after the operation. They all achieved pain free full weight bearing on the fractured ankle and gained a comparable function to their pre-operative state. The mean follow up period was 9 months (range of 2 – 62 months).

Conclusion: Minimally invasive tibiotalocalcaneal fusion is a very useful and successful way of restoring function following a fragility fracture of the ankle. We recommend its use in the cases of fragility fracture of the ankle with poor soft tissue.