Foot and Ankle Fractures in the Elderly Patient

Abstract

In 2009, 36.9 million people living in the USA were over the age of 65 years. It is speculated that by the year 2030, that number will jump to 72.1 million. The increased physical demand of the aging American population has been accompanied by an amplification in the number and severity of ankle and foot fractures in the elderly. This article reviews the various issues associated with ankle and foot fractures in this potentially complex patient population, focusing on risk factors for fracture and the continued debate over surgical versus nonsurgical management. The higher level of activity of the aging American population has significantly increased the incidence of ankle and foot fractures in the elderly. Although certain authors have suggested that osteoporosis is the single strongest risk factor for both foot and ankle fractures, it appears that lifestyle factors such as an increased BMI and a propensity for falling play a larger role in ankle fractures, while foot fractures are more typical fragility fractures. Caused by the prevalence of medical comorbidities in older patients, controversy exists over the optimal management of these fractures. While early investigators cited unacceptable postoperative complication rates and poor outcome following surgical management, more recent studies have demonstrated superior outcome following operative treatment. These authors agree that chronological age should not dictate the management of foot and ankle fractures, but rather level of functional activity and the presence of co-morbid medical conditions. Based on current evidence, the literature supports the surgical treatment of displaced ankle, calcaneus, metatarsal, talus and Lisfranc fractures in geriatric patients who are surgical candidates.

Management of High-Energy Foot and Ankle Injuries in the Geriatric Population

“…This appears to be especially true since data have shown that the use of surgery for injuries of the foot and ankle in the elderly individuals has similar complications and outcomes to those seen in younger patients. [11][12][13][14][15][16][17][18][19][20][21][22][23][24]28,32,33,38,39 The surgical approaches and fixation methods used to manage these injuries are similar to the principles used in the surgical treatment of younger patients, with some slight modifications. With the development of locking plate technology along with improved surgical approaches and techniques, the concerns for providing fixation to pathologic bone have been lessened.…”

Frakturen des Fußes beim älteren Patienten – was ist anders?

“…Aufgrund der steigenden Aktivität im Alter sowie neuer Möglichkeiten, wie z. B. der Einsatz von E-Bikes, ist hier durchaus mit einer steigenden Inzidenz zu rechnen [26].…”

“…Als Risikofaktor wird zum einen die Osteoporose gesehen, hinzu kommen lifestyleassoziierte Faktoren wie z. B. ein erhöhter BMI und eine erhöhte Sturzneigung [26]. Im Alter wird der Unfallmechanismus eher durch ein Niedrigenergietrauma bestimmt.…”

“…Kontrovers wird die optimale Therapie diskutiert, Einfluss haben hier lokale Faktoren sowie vorhandene Komorbiditäten [26].…”

“…Neuere Studien zeigen ein besseres Outcome nach operativer Therapie, das chronologische Alter ist hier für die Indikation nicht wegweisend, eher der funktionelle Aktivitätslevel der Patienten und das Vorhandensein von Komorbiditäten [26].…”