Ankle fractures in the elderly are associated with osteoporosis. They are more likely to have a stable configuration, especially in women (Fox et al 2005), and can be treated in the same way as undisplaced fractures in younger patients.
Displaced fractures require reduction and stabilisation. Makwana et al (2001) showed a small advantage for ORIF over closed casting in the over-55 age group. However, bone stock in elderly patients may be poor and stable fixation difficult to achieve. Relative stability may have to be accepted and protected with a BK cast post-operatively. Nevertheless, good results can be obtained (Srinivasan and Moran 2001).
As an alternative to plating the lateral malleolus, fibular nailing has been described (Gehr et al 2004). Results were probably comparable with those of plating, possibly with fewer wound complications. An RCT comparing nailing and plating in the elderly would be useful.
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