Orthopedic treatment and early weight-bearing for bimalleolar ankle fractures in elderly patients: Quality of life and complications

Lorente, Alejandro; Palacios, Pablo; Lorente, Rafael; Mariscal, Gonzalo; Barrios, Carlos; Gandía, Antonio

doi:10.1016/j.injury.2019.11.028

Cited by 26 publications

(23 citation statements)

References 27 publications

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“…Patients were included consecutively. The exclusion criteria were patients with an injury of the posterior malleolus or a pronation type IV external rotation fracture, patients admitted for a different reason, and patients in whom the cast was broken [ 17 ]. Two patients were excluded from the WB group for weight-bearing [ 17 ].…”

Section: Methodsmentioning

confidence: 99%

“…The exclusion criteria were patients with an injury of the posterior malleolus or a pronation type IV external rotation fracture, patients admitted for a different reason, and patients in whom the cast was broken [ 17 ]. Two patients were excluded from the WB group for weight-bearing [ 17 ]. Incorrect weight-bearing was defined as the inability of the patient to completely step the foot on the ground.…”

Section: Methodsmentioning

confidence: 99%

“…For other types of fractures, such as bimalleolar fractures, early weight-bearing increases quality of life scores more than non-weight bearing does. Non-weight-bearing patients remain in a wheelchair or bedridden for a long time [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

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Quality of life and complications in elderly patients after pronation rotation type III ankle fractures treated with a cast and early weight-bearing

Lorente

Gandía

Mariscal

et al. 2021

BMC Musculoskelet Disord

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Background Early weight-bearing is becoming increasingly common because it can positively affect the quality of life of patients. Therefore, the efficacy and safety of this conservative treatment should be assessed for different types of ankle fractures. The goal of this study was to compare early weight-bearing and non-weight-bearing in terms of effectiveness and safety in patients with pronation rotation type III ankle fractures treated nonsurgically. Methods A prospective multicenter cohort study was conducted over two years. Elderly patients with a nondisplaced pronation rotation type III ankle fracture were included. The main variables were the Barthel Index and SF-12 scores. The patients completed the questionnaires at six weeks, one year and two years. We also compared the complications associated with the two interventions. Results 30 patients were included in the weight-bearing group, while 32 patients were included in the non-weight-bearing (WB) group. The mean ages were 82.6 ± 2.6 years and 83.1 ± 2.6 years, respectively. Quality of life, measured with the SF-12 scale, increased significantly in both the short and long term in the WB group (53.5 ± 5.8 points vs 65.2 ± 4.4 points at 6 weeks and 70.1 ± 4.2 points vs. 80.9 ± 3.7 points at 2 years; p<0.001). The WB group also showed a higher quality of life, as measured by the Barthel Index (54.5 ± 5.2 points vs. 64.3 ± 4.0 points at 6 weeks and 71.0 ± 4.3 points vs. 80.7 ± 3.4 points at 2 years; p<0.001). Conclusions Elderly patients with pronation rotation type III fractures could benefit from an early weight-bearing protocol in terms of quality of life and functionality.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Quality of life and complications in elderly patients after pronation rotation type III ankle fractures treated with a cast and early weight-bearing

Lorente

Gandía

Mariscal

et al. 2021

BMC Musculoskelet Disord

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“… 8 , 9 In ankle-specific studies, risk factors for poor outcomes in geriatric populations include pre-existing diabetes, obesity, 10 nursing home discharge, 11 operative time 12 and weight bearing restrictions. 13 Limited studies summarize the risks and outcomes for ankle fractures in the octogenarian and nonagenarian populations. Thus, this study aims to define these risks associated with co-morbidity burden, dependency status, discharge disposition, as well as to identify adverse outcomes following ORIF of ankle fractures in the octogenarians compared to a non-geriatric patient population.…”

Section: Introductionmentioning

confidence: 99%

Octogenarian and Nonagenarians Are at a Higher Risk for Experiencing Adverse 30-Day Outcomes Following ORIF of Ankle Fractures

Gray

Hidden

Malik

et al. 2021

Geriatr Orthop Surg Rehabil

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Introduction: Despite an increasing number of elderly individuals undergoing surgical fixation for ankle fractures, few studies have investigated peri-operative outcomes and safety of surgery in an octogenarian and nonagenarian population (age >80 years). Materials and Methods: The 2012-2017 American College of Surgeons database was queried for patients undergoing open reduction internal fixation for isolated uni-malleolar, bi-malleolar and tri-malleolar ankle fractures. The study cohort was divided into 3 comparison groups (age <65 years, 65-75 and >80). Multi-variate regression analyzes were used to compare the independent effect of varying age groups on 30-day post-operative outcomes while controlling for baseline clinical characteristics and co-morbidity burdens. Results: A total of 19,585 patients were included: 5.3% were >80 years, 18.1% were 65-79 years, and 76.6% were <65 years. When compared to the non-geriatric population, individuals >80 years were at a significantly Abstract: higher risk of 30-day wound complications (OR 1.84; p = 0.019), pulmonary complications (OR 3.88; p < 0.001), renal complications (OR 1.96; p = 0.015), septic complications (OR 3.72; p = 0.002), urinary tract infections (OR 2.24; p < 0.001), bleeding requiring transfusion (OR 1.90; p = 0.025), mortality (or 7.44; p < 0.001), readmissions (OR 1.65; p = 0.004) and non-home discharge (OR 13.91; p < 0.001). Discussion: Octogenarians undergoing ankle fracture fixation are a high-risk population in need of significant pre-operative surgical and medical optimization. With the majority of patients undergoing non-elective ORIF procedures, it is critical to anticipate potential complications and incorporate experienced geriatric providers early in the surgical management of these patients. Conclusions: Octogenarians and nonagenarians are fundamentally distinct and vulnerable age groups with a high risk of complications, readmissions, mortality and non-home discharges compared to other geriatric (65-79 years) and non-geriatric (<65 years) patients. Pre-operative counseling and risk-stratification are essential in this vulnerable patient population.

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“…These fractures are mostly stable and can be conservatively treated with cast or plastic immobilizers (Figure 1) or treated with surgery. Conservative treatment is indicated in non-displaced fractures, in older patients (2,3) or with limited ambulation (4) , in those with neurological or severe peripheral vascular disease, and in bedridden patients. Poor integumentary status may be also a conditioning in the choice for conservative treatment.…”

Section: Introductionmentioning

confidence: 99%

Mobilization protocol and early postoperative weight-bearing in transyndesmal ankle fractures

et al. 2021

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Objective: To disseminate a rehabilitation protocol with early mobilization and ambulation, with no external supports, reducing the time until full weight-bearing and providing greater postoperative comfort. Methods: We prospectively assessed a series of 68 patients, with level of evidence IV, mean age of 33.3 years. We performed open reduction with ankle lateral approach (Kocher) and internal fixation with an interfragmentary compression screw and a one-third locked tubular plate for neutralization. All patients were subjected to a rehabilitation protocol with early mobilization and weight-bearing. Results: No fracture displacements were observed on the postoperative radiographic controls, neither loosening nor ruptures of implants. There was no need to change rehabilitation guidelines either due to pain or to other subjective limitation. Conclusion: We can state that early joint mobilization and controlled progressive support, with appropriate osteosynthesis, resulting in an early return to everyday activities, both work and sports ones. Level of Evidence IV; Therapeutic Studies; Case Series.

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Orthopedic treatment and early weight-bearing for bimalleolar ankle fractures in elderly patients: Quality of life and complications

Cited by 26 publications

References 27 publications

Quality of life and complications in elderly patients after pronation rotation type III ankle fractures treated with a cast and early weight-bearing

Quality of life and complications in elderly patients after pronation rotation type III ankle fractures treated with a cast and early weight-bearing

Octogenarian and Nonagenarians Are at a Higher Risk for Experiencing Adverse 30-Day Outcomes Following ORIF of Ankle Fractures

Mobilization protocol and early postoperative weight-bearing in transyndesmal ankle fractures

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