{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T08:16:27Z","timestamp":1787991387988,"version":"build-2784847793"},"reference-count":32,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T00:00:00Z","timestamp":1776297600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T00:00:00Z","timestamp":1776297600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Foot Ankle Int."],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The aim of this study was to compare the postoperative complications and functional outcomes of intramedullary fixation (IMF) and conventional plate fixation (PF) for Lauge-Hansen supination external rotation type 4 fractures in patients aged 70 years or older.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This natural experiment involved 2 hospitals (A and B) in a single trauma region. Between June 2019 and January 2023, a total of 80 patients aged 70 years or older with an unstable supination external rotation type 4 fracture were treated with either a geriatric treatment pathway consisting of early-stage IMF following immediate protected full weight bearing in hospital A (n = 48) or PF using a one-third tubular locking plate in hospital B (n = 32). The primary outcome was the total number of postoperative complications during 12 months of follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      The IMF group had a higher mean age compared with the PF group (79.8 vs 75.7 years,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; .001). The total number of postoperative complications was lower in the IMF group compared with the PF group (27% vs 58%,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = .030). Wound infections were observed less frequently following IMF compared to PF (15% vs 35%,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = .031), with infection treatment involving no implant removal in the IMF group (0\/7 for IMF vs 4\/11 for PF). Intramedullary fixation resulted in better functional outcome measured by the Olerud-Molander Ankle Score (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = .040) and less postoperative pain (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; .001) compared to PF, with the greatest relative differences observed at 6 weeks postoperatively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Intramedullary fixation resulted in significantly less postoperative complications and better functional outcome compared to PF, despite the higher mean age of patients in the IMF group. A geriatric treatment pathway using an intramedullary nailing technique may be preferred over conventional PF in an elderly population, especially in case of patient obesity or compromised general health status.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10711007261427486","type":"journal-article","created":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T08:22:28Z","timestamp":1776327748000},"page":"735-743","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Minimally Invasive Intramedullary Fixation vs Plate Fixation of Distal Fibular Fractures in Elderly Patients: A Natural Experiment"],"prefix":"10.1177","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0060-2605","authenticated-orcid":false,"given":"David B.","family":"Tas","sequence":"first","affiliation":[{"name":"Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, the Netherlands"},{"name":"Department of Trauma Surgery, Diakonessenhuis, Utrecht, the Netherlands"},{"name":"Department of Trauma Surgery, Antonius Hospital, Utrecht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diederik P. J.","family":"Smeeing","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery, Rijnstate Hospital, Arnhem, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Egbert Jan M. M.","family":"Verleisdonk","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery, Diakonessenhuis, Utrecht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jort","family":"Keizer","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery, Antonius Hospital, Utrecht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Detlef","family":"van der Velde","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery, Antonius Hospital, Utrecht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roderick M.","family":"Houwert","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, the Netherlands"},{"name":"Utrecht Traumacenter, Utrecht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin L.","family":"Emmink","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery, Gelre Hospital, Apeldoorn, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,4,16]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S8756-3282(02)00832-3"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.2340\/17453674.2025.43006"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2007.08.005"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.fas.2011.03.010"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.jfas.2018.08.028"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1177\/1071100715622392"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1177\/1071100717731757"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13018-024-05032-z"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.fas.2022.03.009"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00264-006-0260-2"},{"issue":"6","key":"e_1_3_2_12_2","first-page":"691","article-title":"Rush rods versus plate osteosyntheses for unstable ankle fractures in the elderly","volume":"22","author":"Pritchett JW","year":"1993","unstructured":"Pritchett JW. 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