Operative Fixation of Unstable Ankle Fractures in Patients Aged Over 80 Years
ABSTRACT Controversy exists regarding the surgical treatment of unstable ankle fractures in the very elderly age group of over 80 years. However, the literature regarding the prognosis of surgery in this elderly group is limited. The purpose of our study was to evaluate the results of patients above 80 years old who underwent operative fixation for unstable ankle fractures.
Ninety-two consecutive patients, 80 females and 12 males, above 80 years of age had open reduction and internal fixation for unstable ankle fractures during the period of January 1998 to August 2007. The data was collected retrospectively from the case records and radiographs. The complications were noted and the risk factors for poor outcome were analyzed. The average age was 85.2 (range, 80.1 to 95.1) years. The minimum duration of followup was 9 months, with an average of 15 (range, 9 to 28) months.
The most common fracture pattern was Danis-Weber B type. The superficial wound infection rate was 7% (6 cases) and the deep infection rate was 4.6% (4 cases). The 30 day postoperative mortality was 5.4% (five cases). Eighty-six percent (75 out of 87 cases) were able to return back to their pre injury mobility at the last followup. Diabetes, dementia, peripheral vascular disease and smoking were found to be statistically significant risk factors associated with wound complications.
The results of operative fixation of unstable ankle fractures were encouraging with good functional recovery and return to pre injury mobility status in most cases.
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ABSTRACT: Injuries to the foot and ankle are often missed or underestimated in patients with polytrauma and are a source of long-term limitations. Injures below the knee are among the highest causes for unemployment, longer sick leave, more pain, more follow-up appointments, and decreased overall outcome. As mortalities decrease for patients with polytrauma a greater emphasis on timely diagnosis and treatment of foot and ankle injuries is indicated. Geriatric patients represent nearly one-quarter of trauma admissions in the United States. This article discusses perioperative management and complications associated with foot and ankle injuries in polytrauma, and in diabetic and geriatric patients.Clinics in Podiatric Medicine and Surgery 10/2014; 31(4). DOI:10.1016/j.cpm.2014.06.007 · 0.51 Impact Factor
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ABSTRACT: Complex fibular fractures as a result of either high-energy mechanisms or advanced age can be difficult to manage as significant comminution can preclude standard operative techniques. Furthermore, the maintenance of osseous reduction postoperatively throughout convalescence can present an equivalent challenge. Strict weightbearing restrictions in the elderly and the noncompliant postoperatively convey an additional risk of potential failure. We present a technique that has offered additional reassurance in these instances. We retrospectively evaluated 25 consecutive patients who had undergone this fibular double plating technique and evaluated the patient outcomes to determine whether this technique conferred any additional risk when weighed against its benefits. All 25 patients underwent benign postoperative courses. No additional operations were performed as a result of this technique. No patient undergoing this technique complained of any hardware irritation, and no hardware removal was required. This double plating technique may confer additional stability to fracture patterns that are inherently unstable. It does not appear to increase the incidence of hardware removal or irritation, and patient morbidity remained low. Based on our results, we advocate this technique especially for comminuted fracture patterns.The Journal of Foot and Ankle Surgery 10/2014; 54(3). DOI:10.1053/j.jfas.2013.08.002 · 0.98 Impact Factor
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ABSTRACT: Most of the literature on surgical site infections following the surgical treatment of fractures of the ankle is based on small series of patients, focusing on diabetics or the elderly. None have described post-operative functional scores in those patients who develop an infection. We performed an age- and gender-matched case-control study to identify patient- and surgery-related risk factors for surgical site infection following open reduction and internal fixation of a fracture of the ankle. Logistic regression analysis was used to identify significant risk factors for infection and to calculate odds ratios (OR). Function was assessed using the Olerud and Molander Ankle Score. The incidence of infection was 4% (29/717) and 1.1% (8/717) were deep infections. The median ankle score was significantly lower in the infection group compared with the control group (60 vs 90, Mann-Whitney test p < 0.0001). Multivariate regression analysis showed that diabetes (OR = 15, p = 0.031), nursing home residence (OR = 12, p = 0.018) and Weber C fractures (OR = 4, p = 0.048) were significant risk factors for infection. A low incidence of infection following open reduction and internal fixation of fractures of the ankle was observed. Both superficial and deep infections result in lower functional scores. Cite this article: Bone Joint J 2014;96-B:636-40.05/2014; 96-B(5):636-640. DOI:10.1302/0301-620X.96B5.33143