Open lower limb fractures in the elderly

Lancaster, Patrick; Kocialkowski, Cezary; Pearce, Oliver; Khan, Umraz; Riddick, Andrew; Kelly, Michael

doi:10.1016/j.injury.2022.03.029

Cited by 8 publications

(2 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…27 In a recent study of open ankle fractures, 56% of patients were managed with single-stage surgery, with limb salvage achieved in 93%. 8 This strategy of single-stage surgery facilitated by a combined orthoplastic approach avoids prolonged bed rest, and eliminates the need for multiple anaesthetics in a vulnerable population. A single-stage approach will not be appropriate in every case.…”

Section: Resultsmentioning

confidence: 99%

“…7 For this cohort of patients, one-year mortality rates have been reported up to 30%, which is comparable to the neck of femur fracture population. 4,8 In the frail patient, the rate of complications after plate fixation of the ankle has been described as between 25% and 40%, 9 with 30% of frail patients having wound infections. 10 Compared to fit patients, the frail patient is at risk of increased mortality rates following multiple surgeries, 11 significant sarcopaenia following just seven days bed rest, 12 and restricted rehabilitation caused increased bed sores, hospital-acquired infections, and veno-thromboembolic events.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Consensus on managing open ankle fractures in the frail patient

Guryel,

McEwan,

Qureshi

et al. 2024

Bone Jt Open

View full text Add to dashboard Cite

AimsAnkle fractures are common injuries and the third most common fragility fracture. In all, 40% of ankle fractures in the frail are open and represent a complex clinical scenario, with morbidity and mortality rates similar to hip fracture patients. They have a higher risk of complications, such as wound infections, malunion, hospital-acquired infections, pressure sores, veno-thromboembolic events, and significant sarcopaenia from prolonged bed rest.MethodsA modified Delphi method was used and a group of experts with a vested interest in best practice were invited from the British Foot and Ankle Society (BOFAS), British Orthopaedic Association (BOA), Orthopaedic Trauma Society (OTS), British Association of Plastic & Reconstructive Surgeons (BAPRAS), British Geriatric Society (BGS), and the British Limb Reconstruction Society (BLRS).ResultsIn the first stage, there were 36 respondents to the survey, with over 70% stating their unit treats more than 20 such cases per year. There was a 50:50 split regarding if the timing of surgery should be within 36 hours, as per the hip fracture guidelines, or 72 hours, as per the open fracture guidelines. Overall, 75% would attempt primary wound closure and 25% would utilize a local flap. There was no orthopaedic agreement on fixation, and 75% would permit weightbearing immediately. In the second stage, performed at the BLRS meeting, experts discussed the survey results and agreed upon a consensus for the management of open elderly ankle fractures.ConclusionA mutually agreed consensus from the expert panel was reached to enable the best practice for the management of patients with frailty with an open ankle fracture: 1) all units managing lower limb fragility fractures should do so through a cohorted multidisciplinary pathway. This pathway should follow the standards laid down in the "care of the older or frail orthopaedic trauma patient" British Orthopaedic Association Standards for Trauma and Orthopaedics (BOAST) guideline. These patients have low bone density, and we should recommend full falls and bone health assessment; 2) all open lower limb fragility fractures should be treated in a single stage within 24 hours of injury if possible; 3) all patients with fragility fractures of the lower limb should be considered for mobilisation on the day following surgery; 4) all patients with lower limb open fragility fractures should be considered for tissue sparing, with judicious debridement as a default; 5) all patients with open lower limb fragility fractures should be managed by a consultant plastic surgeon with primary closure wherever possible; and 6) the method of fixation must allow for immediate unrestricted weightbearing.Cite this article: Bone Jt Open 2024;5(3):236–242.

show abstract

Section: Resultsmentioning

confidence: 99%