OP2: Pretibial Injuries are Unrecognized and Under Treated

Abstract

INTRODUCTION: Pretibial injuries caused by low energy traumas are a distinct medical entity in the morbid elderly population. They present in the anterior leg skin as wounds; pretibial lacerations (PL) or closed hematomas; pretibial hematomas (PH). Comorbidities, compromised independence and dermatoporosis slow down and complicate wound healing. The incidence of pretibial injuries is high, 1 of 36 trauma admissions. MATERIALS AND METHODS: We reviewed the treatment, outcomes and risk factors of patients aged ≥65 years who were treated for a pretibial injury in Kymenlaakso Central Hospital, Finland, during 2015-2019. We focused on surgical treatment and wound healing. RESULTS: We recorded 176 patients (116 PL and 60 PH). The population was mostly female, 71.6%. Mean age was 79.9 years and the most common mechanism of injury was falling on flat ground, 25%. In none of the patient history files pretibial injury, either PL or PH, was mentioned. With PL we found prolonged wound healing, mean 75.2 days, range 0-356, long rehabilitative hospitalization periods, mean 21.1 days, and numerous follow-up visits, mean 18.9, range 0-200. Decisions on surgical treatment were rarely made, only 6 patients were treated with a STSG. With PH we found a delay in hematoma evacuation and a statistically significant correlation (p<0.0001) between dermatoporotic skin and PHs that caused broad skin necrosis. CONCLUSION: Despite being common pretibial injuries are clearly not recognized as a distinct medical entity. PLs require excessive healthcare resources. Early surgical intervention with STSG could facilitate wound healing. PHs among dermatoporotic patients need prompt surgical intervention to prevent skin necrosis and thus further complicated healing.