Outcome of ankle fractures in the elderly

Buckingham, Rachel; Hepple, S.; Winson, Ian

doi:10.1046/j.1460-9584.2000.00213.x

Cited by 31 publications

(24 citation statements)

References 5 publications

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“…However, several authors have highlighted the difficulty of obtaining a satisfactory outcome. [12][13][14][15][16][17][18][19][20] Manipulation and immobilisation in a cast are consistently reported to give unsatisfactory results. Rates of malunion or nonunion are as high as 48% to 73% in patients older than 60 years of age.…”

Section: Discussionmentioning

confidence: 99%

Fragility fractures of the ankle

Lemon

Somayaji²,

Khaleel³

et al. 2005

The Journal of Bone and Joint Surgery. British volume

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Fragility fractures of the ankle occur mainly in elderly osteoporotic women. They are inherently unstable and difficult to manage. There is a high incidence of complications with both non-operative and operative treatment. We treated 12 such fractures by closed reduction and stabilisation using a retrograde calcaneotalotibial expandable nail. The mean age of patients was 84 years (75 to 95). All were women and were able to walk fully weight-bearing after surgery. There were no wound complications. One patient died from a myocardial infarction 24 days after surgery. The 11 other patients were followed up for a mean of 67 weeks (39 to 104). All the fractures maintained satisfactory alignment and healed without delay. Six patients refused removal of the nail after union of the fracture. The functional rating using the scale of Olerud and Molander gave a mean score at follow-up of 61, compared with a pre-injury value of 70.

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Section: Discussionmentioning

confidence: 99%

Fragility fractures of the ankle

Lemon

Somayaji²,

Khaleel³

et al. 2005

The Journal of Bone and Joint Surgery. British volume

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“…Cast immobilisation for highly unstable ankle fractures (especially the inherently unstable pronation-abduction fractures that are frequently seen in the elderly) leads to malunion or nonunion rates between 48% and 73%. 5-7 Numerous comparative studies 5,6,8 including one prospective-randomised study in patients above 55 years of age 8 found significantly better results after open reduction and internal fixation than after non-operative treatment for displaced malleolar fractures in the elderly. Therefore, in the absence of severe systemic comorbidities, the principal indications for surgery should not differ from those in younger patients.…”

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confidence: 99%

Management of ankle fractures in the elderly

Rammelt

2016

EFORT Open Reviews

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The incidence and severity of ankle fractures in elderly patients is increasing steadily. These injuries are challenging to treat and prone to complications.Individual fracture treatment is tailored depending on bone quality, skin conditions, comorbidities, and functional demand of the patient. This article provides a review of current techniques to obtain stable fixation despite poor bone quality. To avoid complications, it is imperative to consider and treat comorbidities such as diabetes and osteoporosis.In the absence of severe systemic comorbidities, the results after open reduction and internal fixation of malleolar fractures in patients above and below 60 years of age are nearly identical, while nonoperative treatment of unstable fractures leads to significantly inferior outcomes. Therefore, the general indications for surgery in elderly patients should not differ from those in younger patients.However, it is essential to detect severe conditions such as Charcot neuro-osteoarthropathy because these require a completely different treatment regime, and standard internal fixation will invariably fail in these patients.Cite this article: Rammelt S. Management of ankle fractures in the elderly. EFORT Open Rev 2016;1:239-246. DOI: 10.1302/2058-5241.1.000023.

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“…Non-operative treatment has been associated with a nonunion rate of between 48% 6 and 73%, [7][8][9] and a malunion rate between 36% 7 and 61% 8 , and the incidence of chronic pain at one year is up to 68%. 9 After open reduction and internal fixation, the rate of nonunion ranges between 0% 10 and 19%, 11 malunion between 5% 10 and 19%, 6,7 and the incidence of wound complications from 9% 10 to 23%. 11 Chronic pain is reported in up to 56% of patients and contributes to high levels (63%) of patient dissatisfaction.…”

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confidence: 99%

“…11 Chronic pain is reported in up to 56% of patients and contributes to high levels (63%) of patient dissatisfaction. 9 A number of factors are believed to contribute to the poor results seen after internal fixation in the elderly. The soft tissues are frequently in poor condition, even prior to injury.…”

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Fragility fractures of the ankle in the frail elderly patient

Al-Nammari

Dawson-Bowling

Amin

et al. 2014

The Bone & Joint Journal

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Conventional methods of treating ankle fractures in the elderly are associated with high rates of complication. We describe the results of treating these injuries in 48 frail elderly patients with a long calcaneotalotibial nail. The mean age of the group was 82 years (61 to 96) and 41 (85%) were women. All were frail, with multiple medical comorbidities and their mean American Society of Anaesthesiologists score was 3 (3 to 4). None could walk independently before their operation. All the fractures were displaced and unstable; the majority (94%, 45 of 48) were low-energy injuries and 40% (19 of 48) were open. The overall mortality at six months was 35%. Of the surviving patients, 90% returned to their pre-injury level of function. The mean pre- and post-operative Olerud and Molander questionnaire scores were 62 and 57 respectively. Complications included superficial infection (4%, two of 48); deep infection (2%, one of 48); a broken or loose distal locking screw (6%, three of 48); valgus malunion (4%, two of 48); and one below-knee amputation following an unsuccessful vascular operation. There were no cases of nonunion, nail breakage or peri-prosthetic fracture. A calcaneotalotibial nail is an excellent device for treating an unstable fracture of the ankle in the frail elderly patient. It allows the patient to mobilise immediately and minimises the risk of bone or wound problems. A long nail which crosses the isthmus of the tibia avoids the risk of peri-prosthetic fracture associated with shorter devices.

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Outcome of ankle fractures in the elderly

Cited by 31 publications

References 5 publications

Fragility fractures of the ankle

Fragility fractures of the ankle

Management of ankle fractures in the elderly

Fragility fractures of the ankle in the frail elderly patient

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