Elsevier

Injury

Volume 44, Supplement 3, September 2013, Pages S20-S22
Injury

Operative management of unstable ankle fractures in the elderly: our institutional experience

https://doi.org/10.1016/S0020-1383(13)70192-XGet rights and content

Abstract

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. This study reports the results of operative management of ankle fractures in the elderly, with regard to functional outcome and complication rates.

This was a retrospective, non-randomized observational study. 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 65years of age and Group B included all patients over the age of 65.

The outcome was measured using the AOFAS Ankle-Hindfoot score and a Linear analog scale.

A total of 120 consecutive patients fulfilled the eligibility criteria and were included in our study (60 patients in each group). We detected statistically significant difference between the LAS score of the two groups (p=0.02), the alignment between the two groups (p=0.04) and the AOFAS score versus LAS score in Group B (p=0.03). Two patients from Group B had wound dehiscence, but finally their wounds healed uneventfully. We didn't observe any serious complications such as skin necrosis, deep infection, osteomyelitis and failure of metalwork.

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.

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)

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