Management of Osteoporotic and Neuropathic Ankle Fractures in the Elderly

Abstract

Purpose of ReviewTreatment of osteoporotic and neuropathic ankle fractures in the elderly is challenging. The purpose of this paper is to review recent publications on this topic and to identify the optimal treatment for these fractures.Recent FindingsTreatment consists of a variety of conservative or operative options all with advantages and disadvantages as described in this review. Little research has been published that specifically focuses on elderly patients with ankle fractures. Operative treatment has a high complication rate. Multiple comorbidities are predictors for complications.SummaryAn optimal treatment could not be distilled but based on the available literature, a general treatment algorithm is proposed. Since the elderly typically are accompanied by multiple comorbidities as well as impaired mobility, the physician should focus not only on treating the fractured ankle but also on the patient as a whole. Further research on this specific topic is needed.

Biomechanics of Osteoporotic Fracture Fixation

“…Open reduction and internal fixation is required in all other more severe cases, in order to obtain a mechanically stable situation and restore the joint's functionality. For elderly patients who require early mobilization, the fracture fixation needs to be stable enough to allow immediate weight-bearing [61]. Depending on the type and severity of the fracture, stability can be achieved by internal fixation with plate osteosynthesis, intramedullary nailing, lag screws, or a combination thereof (Fig.…”

“…In general, the management of ankle fractures in elderly people with osteoporosis needs to be individually considered and the decision-making process can be based on functional demands and the presence of comorbidities with a primary aim of functional restoration allowing early post-operative mobilization [61].…”

Treatment of fragility ankle fractures using hindfoot nail, systemic review

“…15 The conventional treatment methods routinely used (including conservative management, or internal fixation), often provide poor outcomes and risk significant complications (such as non-union/malunion, fixation failure, and DVT) when applied within the geriatric population. 3 This is often multifactorial and can be a result of poor quality skin and soft tissues, osteoporosis and decreased holding strength, and poor mobility. 3,4,16 Recently, HFN has been utilized for the treatment of these osteoporotic ankle fractures.…”

“…However, for fragility ankle fracture that affects patients older than 65 years of age, the aim of surgery is to restore mobility, preserve function and to prevent complications related to non-weight-bearing. [3][4][5][6] Achieving and maintaining anatomical reduction is often difficult due to the complex fracture pattern associated with fragility ankle fractures. 7,8 Following the successful reduction in plaster, Willett, Hearn, & Cuncins observed that these injuries often went on to lose reduction and drift into valgus malalignment, thus increasing the likelihood of developing a malunion or non-union.…”

“…Despite these benefits, surgeons have failed to routinely adopt the use of IM nailing techniques to treat ankle fractures in the same way IM nails are used in the management of tibial and femoral fractures. 3,9 This systematic review aims to investigate the role of hindfoot nails (HFN) in the treatment of fragility ankle fractures. We aim to review the available evidence published on the functional recovery observed in patients following treatment with HFN and the observed complications among the literature.…”