• M Persigant, F Colin, T Noailles, G Pietu, and F Gouin.
• Service d'orthopédie, pôle ostéoarticulaire, CHU Hôtel Dieu, 11, rue Joseph-Caille, 44000 Nantes, France. Electronic address: mike.persigant@gmail.com.
• Orthop Traumatol Sur. 2018 Jun 1; 104 (4): 507-510.

IntroductionRetrograde transplantar intramedullary nailing (TIMN) is a recently described option for ankle fracture in elderly patients with multiple comorbidity contraindicating classical internal fixation. The main objective of the present study was to assess mobility after TIMN for ankle fracture in the elderly. The secondary objective was to assess complications.HypothesisRetrograde TIMN provides reliable fixation of ankle fracture in the elderly, enabling early resumption of walking.Material And MethodsFourteen patients, with a mean age of 79.6years (range: 65-99years), with fracture of the ankle or tibial pilon treated by retrograde TIMN, were prospectively included over a 1-year period (2014-2016). Full weight-bearing with walking cast boot was authorized as of day 1. Mobility was assessed on Parker score in consultation at 6, 12, 24 and 48 weeks.ResultsTen patients were followed up. Mean Parker score was 3.6 (range: 1-5) preoperatively, and 2.4 (range: 1-5) and 2.7 (range: 1-5) at 24 and 48 weeks, respectively: i.e., not significantly different from preoperative values (p=0.057 and p=0.054, respectively). There were no decubitus-related complications. Two patients (20%) showed other complications, including 1 deep infection requiring material ablation. Consolidation was systematic, without hindfoot malunion.DiscussionRetrograde TIMN appeared to be a useful option for ankle fracture in elderly patients for whom classical internal fixation was contraindicated. It allowed immediate resumption of weight-bearing and early rehabilitation, with no increased morbidity or mortality.Level Of EvidenceIV.Copyright © 2018 Elsevier Masson SAS. All rights reserved.

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