Operative management of unstable ankle fractures in the elderly: our institutional experience
Introduction
Ankle fractures represent an exceptionally common injury within the elderly population. The total incidence of ankle fractures has been reported to be up to 184 fractures per 100,000 persons per year, of which 20 to 30 percent occur in the elderly.1 Nowadays, ankle fractures have become an “epidemic”, mainly because of the higher activity levels within the elderly.
Treatment of complex ankle fractures still remains a subject of great controversy. The majority of authors are in favor of nonoperative management, an argument supported by the good late functional results, small number of complications and low cost of treatment as compared to the overall costs of operative management.2 On the other hand, operative management can result in high complication rates, with the infection rate being reported as high as 12%.3, 4 Moreover, osteoporosis is often the cause of poor fixation and can result in an unsatisfactory outcome (in up to 42% of patients).3, 4
On the contrary, the advocates of operative management argue that the patients achieve better functional outcomes following open reduction and internal fixation (ORIF). Anand et al. reported better anatomic congruency and functional results following operative treatment, as compared to non-operative management.5 Besides, other authors report that bad bone quality is not a limiting factor for an operative management.6, 7
This study reports on the results of operative management of ankle fractures in the elderly, with regard to functional outcome and complication rates.
Section snippets
Study design
This was a retrospective, non-randomized observational study. Ethical approval was obtained by the University Hospital of Zagreb and the study was conducted within the principles set out in the Declaration of Helsinki. Informed consent was acquired by each of the participants.
Subjects were identified from a trauma registry kept in our Department and were tested for eligibility. Patients were then categorized into two groups according to their age: Group A included all patients less than 65
Results
A total of 120 consecutive patients fulfilled the eligibility criteria and were included in our study (60 patients in each group). 84 of these patients were female and all patients completed the follow-up. The results of our analysis are summarized in Table 1, Table 2, Table 3, Table 4.
When we compared the AOFAS score in the two groups, we found no statistical significance. There was however statistically significant difference in the LAS score between the two groups (p=0.02).
No statistical
Discussion
Ankle fractures remain a common type of injury in Orthopaedics.1 Because of their complexity and high complication rate, most of them are treated operatively, followed up by a strict rehabilitation program. In order to obtain a successful outcome, anatomic reposition, meticulous surgical technique and early rehabilitation are necessary.11 Certain fracture patterns often do not respond to treatment and can result in a painful, arthritic joint. Anderson et al has also reported that operative
Conclusion
Our study suggests that the operative management of Weber B2 and B3 injuries can result in a favorable outcome. It is however of great importance that there are no delays in treatment, that the reduction is anatomical, that the fracture fixation is satisfactory and that the rehabilitation is commenced early.
Conflict of interest
The authors declare no conflict of interest.
References (21)
- et al.
Cost description of inpatient treatment for ankle fracture
Injury
(2011) The treatment of unstable fractures of the ankle in the elderly
Injury
(1987)- et al.
Ankle fractures in the elderly: MUA versus ORIF
Injury
(1993) - et al.
Measuring foot and ankle injury outcomes: common scales and checklists
Injury
(2011) - et al.
Long-term outcome after 1822 operatively treated ankle fractures: a systematic review of the literature
Injury
(2011) - et al.
Satisfaction with pain relief after operative treatment of an ankle fracture
Injury
(2012) - et al.
Internal fixation of ankle fractures in the very elderly
Injury
(2001) - et al.
Rest easy? Is bed rest really necessary after surgical repair of an ankle fracture?
Injury
(2012) - et al.
The epidemic of ankle fractures in the elderly–is surgical treatment warranted?
Arch Orthop Trauma Surg
(2000) - et al.
Displaced ankle fractures in patients over 50 years of age
J Bone Joint Surg Br
(1983)
Cited by (17)
The association between person and fracture characteristics with patient reported outcome after ankle fractures in adults: A systematic review
2022, InjuryCitation Excerpt :No studies registered their study protocols in a public registry. Of the 51 studies, 34 (67%) were retrospective cohort studies [35–68], 8 (15%) prospective cohort studies [69–76], 5 (10%) matched cohort studies [77–81] and 4 (8%) cohort studies recruiting participants from randomised controlled trials [82–85]. Fifty-one studies were classified as phase 1 explanatory studies [27,28].
Surgical Considerations for Osteoporosis in Ankle Fracture Fixation
2019, Orthopedic Clinics of North AmericaCitation Excerpt :Ankle fractures occurring in the geriatric patient can present a technical challenge because of the osteoporotic nature of the bone and medical comorbidities. Literature suggests that geriatric ankle fractures (>age 65 years) can be performed with reliable results similar to that of younger patients.5 Even though a high rate of return (85%) to preinjury level has been reported the general complication rate is not insignificant, ranging from 4.6% to 21%.6–8
The role of intramedullary fixation in ankle fractures – A systematic review
2018, Foot and Ankle SurgeryCitation Excerpt :In addition, Anderson et al. report a statistically significant rise in the complication rate in patients over 65 years from 11% to 40% if internal fixation is performed [16]. However, comparative studies have shown an improved outcome when compared to non-operative treatment [17,18]. Even when surgical fixation is used, the choice of implant remains controversial.
Are low-energy open ankle fractures in the elderly the new geriatric hip fracture?
2015, Journal of Foot and Ankle Surgery