The Use of Hindfoot Nails for Elderly Complex Distal Tibial and Ankle Fractures.

Elderly patients who sustain complex ankle or distal tibial fractures are often frail and comorbid and need surgery to contain the talus underneath the tibia in order to protect the soft tissue envelope and allow early unrestricted weightbearing. We performed a retrospective observational review of patients >65 years old who underwent a hindfoot nail fixation of an ankle or distal tibial fracture in our institution. Data collected included: injury sustained, open or closed injury, ASA grade, age at time of surgery, length of stay, postoperative mortality, complications, and further treatment. The primary outcome was reoperation. Secondary outcomes were infection and 1 year mortality. Seventy hind foot nailing procedures were undertaken. Sixty-three out of 70 patients were female. The average age of those who died within 1 year of surgery was 84 years. Forty-five out of 70 were open injuries. Eleven out of 70 patients died with 1 year of surgery (range 1-358 days postsurgery). Five out of 70 (7%) patients developed an infection. Four out of 5 of these injuries were open. Three out of 5 underwent removal of the nail due to infection. Two out of 5 had the infection suppressed with antibiotics. Ten out of 70 (14%) patients underwent locking bolt removal due to it backing out or being prominent and causing wound healing issues. Two out of 70 (3%) patients went on to have below knee amputations. Both were due to ongoing wound problems following open fractures. The hindfoot nail is an important implant when treating complex ankle and distal tibial fractures in an elderly population. It facilitates early mobilization to avoid deconditioning and other medical complications.

An Alternative Method of Tensioning Traction Within Thomas Splint.

The application of a Thomas splint when managing a femoral fracture has the potential to be a painful experience for the patient. If movement of the injured limb can be reduced during the application then the patient will likely suffer less pain. In this report, we describe a method that enables the clinician to remove any slack in the tensioning system and apply the traction in a single movement. No additional equipment is required beyond the standard splint and skin traction apparatus. A pulley system is created using the cord, the splint and two overhand knots, minimising movement at the injury site whilst permitting sufficient traction to be applied. Once applied, it can be easily re-tensioned as the thigh musculature relaxes. We believe this method to be simple, more adaptable and quicker to apply than the current standard.