100 elderly patients (>65 years) with unstable ankle fractures requiring fixation were randomized to receive fibular nailing or standard open reduction and internal fixation (ORIF) using AO techniques. Over 12 months, there were significantly fewer wound infections in the fibular nail group than in the ORIF group. The cost of treatment for the fibular nail group was lower than that of the ORIF group, and the fibular nail group was also significantly happier with the condition of their scar. The results indicate that fibular nailing provides superior short term complication rates and cost-effectiveness compared to ORIF. However, the abstract did not mention a comparison in the accuracy of the reduction which can have a significant effect on long-term outcomes.
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