Article

Operative Fixation of Unstable Ankle Fractures in Patients Aged Over 80 Years

Wirral University Hospitals NHS Trust, Arrowe Park Hospital, Arrowe Park Road, Upton, Wirral CH45 5PE, United Kingdom.
Foot & Ankle International (Impact Factor: 1.51). 06/2011; 32(6):599-602. DOI: 10.3113/FAI.2011.0599
Source: PubMed

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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    • "Previously, the trend was to treat all osteoporotic ankle fractures non-surgically due to the high compli cation rate [70] [73] [74]. Rates of malunion or non-union of up to 73% have been described in geriatric patients treated by closed reduction and cast immobilisation [70] [73] [75]; however, recent studies have shown better functional outcome with operative treatment of ankle fractures in elderly patients [70] [71] [76] [77] [78]. External fixators are described as an alternative treatment option to locking plate osteosynthesis, tension-band technique, fibular intramedullary devices, and arthrodesis [70] [71]. "
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    • "Postoperative wound infections are the most commonly reported complication. The rates of postoperative wound problems range from 7% to 13% [10] [11] [17]. Complications have been reported to be higher in the presence of co-morbidities (19.01%) and in patients without co-morbidities (11.96%) [17]. "
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