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The incidence of osteoporosis is increasing as the elderly population grows. Because these patients remain active, fragility fractures of the ankle are becoming more common. The literature indicates a relatively high complication rate for non-operative management of ankle fractures in this patient cohort, leading surgeons to face challenges unique to patients with poor bone and skin quality. This article discusses techniques to address osteoporotic ankle fractures and reviews the current literature relevant to this issue.

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Exsanguination is the second most common cause of death in patients who suffer severe trauma. The management of haemodynamically unstable high-energy pelvic injuries remains controversial, as there are no universally accepted guidelines to direct surgeons on the ideal use of pelvic packing or early angio-embolisation. Additionally, the optimal resuscitation strategy, which prevents or halts the progression of the trauma-induced coagulopathy, remains unknown. Although early and aggressive use of blood products in these patients appears to improve survival, over-enthusiastic resuscitative measures may not be the safest strategy. This paper provides an overview of the classification of pelvic injuries and the current evidence on best-practice management of high-energy pelvic fractures, including resuscitation, transfusion of blood components, monitoring of coagulopathy, and procedural interventions including pre-peritoneal pelvic packing, external fixation and angiographic embolisation.