Ankle fractures in the elderly: Current concepts

Pearce, Oliver; Al-Hourani, Khalid; Kelly, Michael

doi:10.1016/j.injury.2020.10.093

Cited by 27 publications

(19 citation statements)

References 103 publications

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“…34,35 Whilst such care pathways for hip fractures are well defined, it has been stated that fractures around the ankle are as devastating but largely overlooked, even though they are the third most common fracture location and with studies indicating a rising incidence and severity as well as worsening of functional outcome with age. 36-39 This study also found low QoL outcomes in ankle fracture patients and therefore, we encourage future studies to establish evidence-based treatment recommendations.…”

Section: Discussionmentioning

confidence: 67%

The Quality of Life, Patient Satisfaction and Rehabilitation in Patients With a Low Energy Fracture—Part III of an Observational Study

Vet

Kusen

Rohner-Spengler

et al. 2021

Geriatr Orthop Surg Rehabil

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Introduction Due to the aging population the incidence of Low Energy Fractures (LEF) increases. LEF have high mortality and morbidity rates and often cause elderly to lose independence. Patient-reported outcomes, such as Quality of Life (QoL) and patient satisfaction (PS) are needed to evaluate treatment, estimate cost-benefit analyses, and to improve clinical decision-making and patient-centered care. Objective The primary goal was to evaluate QoL and PS in patients with LEF, and to compare QoL scores to the community dwelling population. Second, we observed the amount and type of physiotherapy (PT) sessions the patients conducted. Methods A single-center cohort study was conducted in Switzerland. Patients between 50 and 85 years, who were treated in the hospital for LEF, were followed 1 year after initial fracture. Data on QoL were obtained through the Euroqol-5-Dimension questionnaire-3-Level (EQ-5D-3L) and the EQ VAS (visual analog scale). PS was measured by a VAS on satisfaction with treatment outcome. Data on PT sessions, mobility and use of analgesics were collected by telephone interviews and written surveys. Results were compared between the different fracture locations and subgroup analyses were performed for age categories. Results 411 patients were included for analysis. The median scores of the EQ-5D-3L index—VAS and PS were 0.90 (0.75–1.0), 90 (71.3–95) and 100 (90–100). Significant differences in all scores were found between fracture location ( P < .05), with hip fracture patients and patients with a malleolar fracture scoring lowest in all measures. QoL index in hip fracture patients was 0.76 (0.70–1.00), QoL VAS 80 (70–90), and PS 95 (80–100). Median amount of PT sessions in all patients was 18 (9–27) and a significant difference was found between fracture locations. Patients with a fracture of the humerus received the highest amount of PT sessions 27 (18–36), hip fracture patients had a median of 18 (9–27) sessions. Conclusion At follow-up, QoL throughout all patients with a LEF was comparable to a normal population. Remarkably, though hip fracture patients seem to suffer from a clinically relevant loss of QoL, they received fewer PT sessions and performed fewer long-lasting home training than patients with a humerus fracture. Intensive, progressive rehabilitation with a high frequency of supervised training is recommended after hip fracture. The low frequency of PT sessions found in this study is unsatisfying. In hip fracture patients and in patients with a malleolar fracture, especially when aged over 75 years, more efforts are required to improve rehabilitation and subsequently QoL.

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Section: Discussionmentioning

confidence: 67%

The Quality of Life, Patient Satisfaction and Rehabilitation in Patients With a Low Energy Fracture—Part III of an Observational Study

Vet

Kusen

Rohner-Spengler

et al. 2021

Geriatr Orthop Surg Rehabil

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“…With open reduction and internal fixation, surgical access is a major limiting factor and the use of multiple screws in weakened bone presents an additional risk [8]. In elderly patients, the postoperative complication rate after plate and screw fixation of lateral malleolar fractures was shown to be as high as 40% [5,7,8,10].…”

Section: Discussionmentioning

confidence: 99%

A Novel Technique for Treatment of Peri-Implant Tibial Shaft Fracture with Pre-Existing Bimalleolar Ankle Fracture with a Combination of IlluminOss® Photodynamic Bone Stabilization System and Osteosynthesis

Said¹,

Saad²,

Johannes³

2023

Int J Foot Ankle

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“…Especially in incompliant elderly patients and patients with poor bone quality, quadricortical instead of tricortical screw insertion and two instead of one screw can be considered to have more fixation stability ( 60 , 61 ). A tibia-pro-fibula technique is an option in osteoporotic multifragment fibula fractures to aim for increased resistance to torque, rotational angulation and force preventing fixation failure ( 62 , 63 , 64 , 65 , 66 ).…”

Section: Open Reduction and Internal Fixationmentioning

confidence: 99%

Ankle fractures of the geriatric patient: a narrative review

et al. 2023

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The present narrative review provides a summary of current concepts for the treatment of ankle fractures in elderly patients. Despite a high complication rate, open reduction and internal fixation is the gold standard for operative care. However, individual patient-based treatment decision considering the soft-tissue status, the fracture pattern, as well as the patient’s mobility and comorbidities is mandatory to achieve sufficient patient outcomes. Due to high complication rates after surgery in the past, techniques such as fibular nails or minimal invasive techniques should be considered.

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Ankle fractures in the elderly: Current concepts

Cited by 27 publications

References 103 publications

The Quality of Life, Patient Satisfaction and Rehabilitation in Patients With a Low Energy Fracture—Part III of an Observational Study

The Quality of Life, Patient Satisfaction and Rehabilitation in Patients With a Low Energy Fracture—Part III of an Observational Study

A Novel Technique for Treatment of Peri-Implant Tibial Shaft Fracture with Pre-Existing Bimalleolar Ankle Fracture with a Combination of IlluminOss® Photodynamic Bone Stabilization System and Osteosynthesis

Ankle fractures of the geriatric patient: a narrative review

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