Results of Operative Fixation of Unstable Ankle Fractures in Geriatric Patients

Abstract

It is widely accepted that operative fixation of unstable ankle fractures yields predictably good outcomes in the general population. The current literature, however reports less acceptable results in the geriatric population age 65 years and older. The current study analyzes the outcome of the surgical treatment of unstable ankle fractures in patients at least 65 years old. Twenty three patient over 65 years old were surgically treated after sustaining 21 (91%) closed and 2 (9%) open grade II unstable ankle fractures. Fractures were classified according to the Danis-Weber and Lauge-Hansen schemes. Fracture type was predominantly Weber B (21/23, 91%), or supination external rotation stage IV (21/23, 91%). Fracture union rate was 100%. There were three significant complications including a lateral wound dehiscence with delayed fibular union in an open fracture dislocation, and two below knee amputations, neither of which was directly related to the fracture treatment. There were three minor complications; one superficial wound infection and two cases of prolonged incision drainage, all of which resolved without further surgical intervention. Complications were associated with open fractures and preexisting systemic disease. These results indicate that open reduction and internal fixation of unstable ankle fractures in geriatric patients is an efficacious treatment regime that with results that are comparable to the general population.

Risk Factors for Wound Complications After Ankle Fracture Surgery

“…Most are stable fractures that are easily treated nonoperatively. Surgical treatment of the unstable ankle fracture generally is associated with improved outcomes, even in geriatric patients 2,3 . The overall rate of complications after open reduction and internal fixation of ankle fracture varies between 5% and 40%, depending on the population investigated 4 .…”

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.…”

“…24 This has been validated by other studies 22,23 and has demonstrated similar findings for the management of ankle fractures in the elderly individuals. [11][12][13][14][15][16][17][18][19][20][21] Using this as a guide, such complications as the development of post-traumatic arthritis may be higher in the elderly patients, perhaps due to preexisting arthritis, but good outcomes can be obtained with very few patients needing an arthrodesis as a salvage for their management of pain. 24 A second problem is in dealing with complications associated with patient comorbidities.…”

“…However, studies, with and without the use of locking plates, have demonstrated good to excellent outcomes of operative treatments of ankle fractures in the elderly individuals. 12,[15][16][17][18]25,26 Additionally, in studies comparing operative versus nonoperative techniques, better outcomes using surgery have also been demonstrated due to the ability of the implant to maintain the reduction until healing has occurred. 13,14,[19][20][21]29,33,35,38 Since locked plates have shown an improvement in the fixation of osteopenic and osteoporotic bone, they should be used.…”

“…Four articles were found to be mentioning elderly patients with talus, midfoot, or metatarsal fractures, but these were either review articles offering no specific treatment for the elderly population 30,31 or simply discussed the incidence of these injuries in older patients. 40,41 The only injuries to mention specific evaluations and treatment of fractures in the elderly individuals were those involving the ankle [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26]28,29,[31][32][33][34][35][36][37][38] or calcaneus. [22][23][24]39 Among these 2 specific fractures, most ankle fractures occurred from simple ground level falls.…”