Tibiotalocalcaneal nailing for osteoporotic ankle fractures in the frail patient: a narrative review with a clinical score proposal for the decision-making process

Abstract

Osteoporotic ankle fractures result from mechanical forces that would not ordinarily result in fracture, known as ‘low-energy’ trauma, such as those equivalent to a fall from a standing height or less. Osteoporotic ankle fractures in frail patients are becoming more and more frequent in daily practice and represent a therapeutic challenge for orthopaedic surgeons. The main problems with frail patients are the poor condition of the soft tissues around the ankle, dependence for activities of daily living and high comorbidity. The decision to operate on these patients is complex because conservative treatment is poorly tolerated in unstable fractures and conventional open reduction and internal fixation is associated with a high rate of complications. The authors conducted a narrative review of the literature on primary tibiotalocalcaneal nailing of ankle fractures in frail patients and categorized the different factors to consider when treatment is indicated for this conditon. Difficulty of ambulation, age over 65 years old, deteriorated baseline state and instability of the fracture were the most frequently considered factors. Finally, the authors propose an easy and quick clinical scoring system to help in the decision-making process, although further comparative studies are required to explore its validity.

Risk factors for rehospitalization within 90 days in patients with total joint replacement: A meta-analysis

“…A variety of studies have highlighted the ASA classification as a reliable prognosticator for perioperative morbidity. [ 17 ] Patients with higher ASA classes are at risk of developing higher rates of postoperative medical complications after multiple orthopedic procedures. [ 18 ] Moreover, high ASA class was associated with the highest odds of readmission.…”

Treatment strategies for complex ankle fractures—current developments summarized in a narrative review

“…Alternatively distal fibula fractures can be addressed with minimally invasive techniques, such as intramedullary nailing. This can be a viable option in severely impacted soft tissue and elderly patients ( 58 ). Rouhani and coworkers found no difference in the outcome after tibial pilon fractures with compared to without fixation of the distal fibula in their retrospective study at two-year follow-up ( 53 ).…”

“…Multiple authors have discussed the specific challenges accompanied in treatment of ankle fractures in the geriatric population. The reoccurring problems with treating ankle fractures in elderly patients are compromised soft tissue, osteoporotic bone and significant comorbidities ( 58 ). Due to this combination of problems the treatment of these fractures is particularly difficult.…”

“…So far ankle arthrodesis has mainly been used as a salvage technique for severe osteoarthritis or after failed ORIF. Yet recently multiple authors have presented good results, when using ankle arthrodesis as a primary treatment option ( 14 , 30 , 58 , 96 ). The main argument for using a minimally invasive retrograde nail primarily is the limited soft tissue mantle in elderly patients.…”

Postprimäre frühelektive Totalprothetik bei schweren Frakturen des oberen Sprunggelenks

“…Die postprimär vorliegenden Befunde müssen gut und kritisch evaluiert werden, um das beste Ergebnis für den Patienten zu erzielen. Bei älteren Patienten mit einer Osteoporose, einem geringeren funktionellen Anspruch und einer instabilen Fraktur des OSG kann die Arthrodese des Sprunggelenks die bessere Therapiealternative darstellen [ 12 ]. Anders gestaltet sich dies bei sportlich aktiven Patienten mit einer Pilonfraktur.…”