Title : Clinical outcomes of Intra-Medullary Hindfoot Nailing (IMHN) for traumatic ankle fractures: A six-year experience from a UK tertiary centre
Abstract:
Introduction: Intra-Medullary Hindfoot Nailing (IMHN) is utilised for complex ankle fractures in frail patients where conventional fixation is unsuitable. However, outcome data in trauma populations remains sparse.
Aim: To evaluate short-term outcomes, complications, and mortality following IMHN for traumatic ankle fractures in a UK tertiary centre.
Methods: A retrospective review of IMHN for traumatic ankle fractures between December 2018 and August 2025, was performed using Bluespier coding. Demographics, injury characteristics, surgical timing, complications, radiographic outcomes, and mortality were collected.
Results: Seventy-five patients were included (median age 79 years, IQR 72–86); 62 (82.7%) were female and 57 (76.0%) classified as frail. Median body mass index was 31.3. Injury severity was high, with 37 (49.3%) open fractures and 43 (57.3%) tri-malleolar injuries. Median time to surgery was 8 days, with 47 (62.7%) delayed beyond 72 hours. Immediate full weight-bearing was advised post-operatively in 65 patients (86.7%). Complications occurred in 14 (18.7%), seven (9.3%) metalwork related, six (8.0%) infection related, and one (1.3%) periprosthetic fracture. Ten (13.3%) cases required re-operation. Radiographic follow-up was available in 55 (73.3%), demonstrating union in 36 (65.5%) and malunion in two (3.6%); 17 patients (30.9%) had no evidence of union. Eleven patients (17.5%) returned to baseline mobility. Mortality was one (1.3%) at 30 days and 11 (17.7%) at one year. There was no statistically significant difference in 1-year mortality between open vs closed fractures (11% vs 26%; p=0.137, Fisher’s exact test).
Conclusion: IMHN is an effective stabilisation strategy in frail patients with complex ankle fractures, allowing early mobilisation. However, complication rates remain considerable, with limited functional recovery and high mortality. Outcomes parallel hip fracture cohorts, supporting the need for careful patient selection, early surgery where feasible, and orthogeriatric optimisation, though findings are limited by small sample size.
