Table 3.

Summary of selected articles highlighting TTC nailing for fragility ankle fractures.

Reference	Type	LOE	Sample	Age	Inclusion criteria	Nail	Postop WB	FU (months)	Complications
Lemon et al. (7)	RT	IV	12	84	Unstable fracture pattern	Long expandable humeral nail	Full	16	8.3%: three DVT
Amirfeyz et al. (2)	RT	IV	13	78.9	Age >60; frail physical state; poor bone stock; poor ankle soft tissues; Unstable fracture pattern; failed primary ORIF.	Humeral nail and TTC nail	Partial	11	7.7%: one minor wound breakdown one delayed union
O´Daly et al. (8)	RT	IV	9	81	Ankle fragility fractures; failed conservative treatment	Long humeral nail	Full	34	No
Jonas 2013 (12)	RT	IV	31	77	Fragility ankle or distal tibia fracture; patient´s mobility; patient´s morbidity; patient´s compliance with NWB; unstable fracture pattern.	TTC nail	Full	18	38.7%: two periimplant fractures; two broken nails
Al-Nammari et al. (1)	RT	IV	48	82	Physically and/or mentally frail; restricted mobility; poor bone stock; ASA score > 3	Long femoral nail	Full	6	47%: two superficial infections, one deep infection, three broken distal screw, two valgus malunion, one BKA
Taylor et al. (10)	RT	IV	31	63	Ankle or pilon low-energy fractures.	TTC nail	*Full/Partial	13.6	29.1%: three Implant failures, two superficial infections, three deep infections, one BKA
Georgiannos et al. (5)	PT	II	37	78	Over 70 years of age; unstable fracture pattern.	TTC nail	Full	12	8.1%: one superficial infection, one DVT, one Protrusion of the nail
Persigant et al. (9)	RT	IV	14	79.6	Over 65 years of age; Restricted mobility (walking distance < 500 meters); ASA score ≥ 2.	Long femoral nail	Full	12	20%: one deep infection, one distal screw loosening
Baker et al. (3)	RT	IV	16	73	Poor baseline mobility; unstable fracture pattern; unsuitable for standard ORIF or external fixation	Long femoral nail	Non WB 10–-10days10 days (then full WB)	21	Nr
Ebaugh et al. (4)	RT	IV	27	66	Ankle fracture; Complicated diabetes	TTC nail	Non WB until healing of plantar wound (then full WB)	29.6	18.5%: one superficial infection, three deep infections, one nail failure, one AKA
Herrera-Perez et al. (11)	RT	IV	17	81.5	Over 65 years of age. Periarticular fragility ankle fracture.	TTC nail	Full	20.9	23,5%: one distal screw loosening, one painful subtalar nonunion, one superficial infection

*According to surgeon preference.

AKA, above-knee amputation; ASA, Functional score from the American Society of Anaesthesiology; BKA, below-knee amputation; DVT, deep vein thrombosis; FU, follow-up; LOE, level of evidence; Nr, non reported; NWB, Non-weight-bearing; ORIF, open reduction and internal fixation; PT, prospective; RT, retrospective; TTC, tibiotalocalcaneal; WB; weight-bearing.