The management of ankle fractures in octogenarian and nonagenarians. What is the optimum mode of treatment?
Journal Title: International Journal of Orthopaedics Sciences - Year 2017, Vol 3, Issue 1
Abstract
Introduction: The rapidly growing elderly population is living longer, active lifestyles with significant comorbidities. Modern literature challenges the conservative approach to elderly ankle fractures. Our aim is to investigate the outcome of ankle fractures in patients aged over 80 years of age by treatment modality. Methods: We retrospectively reviewed all consecutive displaced ankle fractures requiring admission in patients over 80 years old at our level 1 trauma centre over 5 years. Conservative management was compared with open reduction and internal fixation (ORIF) and external fixation (Ex-Fix) as a mode of definitive treatment. Primary outcomes measures included length of stay, wound complications including infection, thromboembolic disease and mortality. Results: We reviewed 35 fractures with 9 Ex-Fix, 6 ORIF’s and 20 managed conservatively. Surgical intervention resulted in longer lengths of stay compared to conservative management with a median length of stay of 19.5 compared to 51 in the surgical group (p=0.006). ORIF provided good reduction at a cost of wound infections and the need for further procedures. Ex-Fix had the highest risk of mortality and risk of malunion (33%). Conservative management experienced malunion in 25% but avoided the surgical complications. Discussion: Complications were experienced in all groups reflecting the difficult management decisions posed in these patients. A patient-by-patient assessment and discussion is key to assess function and physical demands. For low demand and frail patients conservative therapy is a logical choice. ORIF can be considered in the more active and independent as long as the risks are fully understood.
Authors and Affiliations
James Holton, Rajpal Nandra, Dr. Daniel Thurston, Seyed Ali
Keywords
Related Articles
- EP ID EP500194
- DOI 10.22271/ortho.2017.v3.i1f.70
- Views 119
- Downloads 0
A prospective comparative study between conservative and operative treatment with dynamic hip screw in the management of intertrochanteric fracture of the femur
Introduction: Trochanteric fracture of femur is extremely common in elderly age group. Nowadays, most of these fractures will be surgically fixed with implants. However, some patients can be treated with conservative tre...
Outcome of one level instrumented posterior lumbar interbody fusion in indicated cases of prolapsed intervertebral disc (PIVD) – A clinical study
Introduction: Lumbar disc herniation is one of the most common spinal degenerative disorders which lead to low back pain (LBP) and radicular leg pain. Heavy lifting, twisting and trauma were the most common causes of LBP...
Comparison of outcome of unilateral plating and dual plating in treatment of bicondylar tibia plateau fractures
Introduction: Fractures of the proximal tibia, particularly those that extend into the knee joint are termed as tibial plateau or tibial condylar fractures. It results from indirect coronal or direct axial compressive fo...
A nature friendly knee arthroplasty for prayer and meditation in Asiatic lifestyle
Introduction: India is a country where many religions coexist together. Prayer & meditation form an integral part of Indian lifestyle. Also 90% of India’s population lives in the rural areas. Medial compartment osteoarth...
Clinical outcome of single intra articular injection of triamcinolone acetonide depot preparation on knee osteoarthritis
Oral pharmacological agents are not effective for long term and have many side effects if used for longer period of time. Intraarticular injection of hyaluronic acid injections and other biological agents like bone marro...