Fragility fractures of the ankle in the frail elderly patient

Abstract

Conventional methods of treating ankle fractures in the elderly are associated with high rates of complication. We describe the results of treating these injuries in 48 frail elderly patients with a long calcaneotalotibial nail. The mean age of the group was 82 years (61 to 96) and 41 (85%) were women. All were frail, with multiple medical comorbidities and their mean American Society of Anaesthesiologists score was 3 (3 to 4). None could walk independently before their operation. All the fractures were displaced and unstable; the majority (94%, 45 of 48) were low-energy injuries and 40% (19 of 48) were open. The overall mortality at six months was 35%. Of the surviving patients, 90% returned to their pre-injury level of function. The mean pre- and post-operative Olerud and Molander questionnaire scores were 62 and 57 respectively. Complications included superficial infection (4%, two of 48); deep infection (2%, one of 48); a broken or loose distal locking screw (6%, three of 48); valgus malunion (4%, two of 48); and one below-knee amputation following an unsuccessful vascular operation. There were no cases of nonunion, nail breakage or peri-prosthetic fracture. A calcaneotalotibial nail is an excellent device for treating an unstable fracture of the ankle in the frail elderly patient. It allows the patient to mobilise immediately and minimises the risk of bone or wound problems. A long nail which crosses the isthmus of the tibia avoids the risk of peri-prosthetic fracture associated with shorter devices.

Management of ankle fractures in the elderly

“…Therefore, it should only be an option in bedridden patients. 41 Hindfoot fusion with specially designed, curved nails is an excellent treatment option for patients with Charcot neurogenic osteoarthropathy of the ankle/hindfoot type (Sanders IV), because standard techniques of internal fixation will invariably fail in these patients. 17 Alternatively, a small wire external fixator may be used.…”

Management of Osteoporotic and Neuropathic Ankle Fractures in the Elderly

“…It allows the patient to mobilize immediately. Al Namari et al studied 48 frail elderly patients with displaced ankle fractures who were treated with a long calcaneotalotibial nail [26•]. The mean age of the group was 82 years (61 to 96) and 85% were females.…”

“…Complications included superficial infection (4%), deep infection (2%), a broken or loose distal locking screw (6%), valgus malunion (4%), and one below-knee amputation following an unsuccessful vascular operation. There were no cases of nonunion, nail breakage, or peri-prosthetic fracture [26•]. Jonas et al studied 31 patients with a short retrograde tibiotalar-calcaneal nail and found no postoperative wound problems [27].…”

Salvaging a Severely Burned Ankle Using Arthrodesis and Anterolateral Thigh Free Flap

“…Patients who are not independently mobile are at an elevated risk of complications, such as pressure sores, pneumonia, and deep vein thrombosis, and their mortality is increased from these conditions. Treatment that enables weightbearing as rapidly as possible following surgery leads to better prognosis in older patients [1,2]. Therefore, if there is severe soft tissue damage, early amputation can be performed in order to shorten the time required until the patient is bearing weight with the prosthesis.…”