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Less invasive intramedullary fibular nail (FN) fixation may reduce soft-tissue trauma and enable earlier mobilization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In this prospective multicenter trial with pseudorandomized allocation and protocol-permitted crossover, 55 geriatric multimorbid patients (Charlson Comorbidity Index\u2009\u2265\u20094; mean age FN 79\u2009\u00b1\u20098 vs. ORIF 74\u2009\u00b1\u20098 years;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.053) were treated with FN (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200939) or ORIF (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200916). Primary outcomes were operative time, fluoroscopy time, hospital stay, weight-bearing at discharge, complications, and functional scores (AOFAS, OMAS, Weber) at six weeks and twelve months.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      FN required more fluoroscopy time (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.011), while operative duration and hospital stay were comparable (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.176,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.520). Full weight-bearing at discharge was more frequent after FN (62% vs. 0%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). At six weeks, FN patients achieved higher functional scores (AOFAS\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.041; OMAS\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.027), but at twelve months no differences remained (AOFAS\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.404; OMAS\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.288; Weber\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.585). Radiographic malalignment was more common after FN (46% vs. 13%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.031). Distal screw loosening at twelve months occurred more often after FN (80% vs. 11%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.005) but was mostly asymptomatic.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Earlier mobilization observed after FN in our study primarily reflects the permissive postoperative weight-bearing protocol rather than an inherent biomechanical advantage of the implant. At twelve months, functional outcomes were equivalent, underscoring that protocol-driven early loading, not implant design, explains early differences.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00068-026-03108-5","type":"journal-article","created":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T09:22:28Z","timestamp":1771838548000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Fixing geriatric ankle fractures: fibular nail versus locking plate in a prospective multicenter study"],"prefix":"10.1007","volume":"52","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6863-9025","authenticated-orcid":false,"given":"Felix C.","family":"Kohler","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zoe","family":"Berfelde","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Schenk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wolfram","family":"Weschenfelder","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Britt","family":"Wildemann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Kobbe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Mendel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernhard W.","family":"Ullrich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,2,23]]},"reference":[{"issue":"1","key":"3108_CR1","doi-asserted-by":"publisher","first-page":"43","DOI":"10.3109\/17453679809002355","volume":"69","author":"CM Court-Brown","year":"1998","unstructured":"Court-Brown CM, McBirnie J, Wilson G. 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