Techniques and Considerations for the Operative Treatment of Ankle Fractures in the Elderly.

Abstract

* In managing fragility fractures about the ankle, nonoperative treatment should be considered with the caveat that soft-tissue integrity is of the utmost importance.* Consultation with medical and nutritional services for the comanagement of elderly patients with a fragility ankle fracture improves outcomes.* Soft-tissue preservation in the elderly is optimized with the judicious use of a tourniquet.* In elderly patients, a congruent ankle joint with axial alignment and stability should be emphasized over achieving anatomic articular reduction.* Less invasive surgical techniques, such as percutaneously placed anterior-to-posterior screws for posterior malleolar fractures and intramedullary fibular fixation, should be considered in the elderly.* Construct stability in elderly patients is maximized with the use of lateral locking plates, tibia-pro-fibula screws, and bicortical medial malleolar screws.* The use of external fixation with hydroxyapatite-coated pins should be considered in the treatment algorithm for fragility ankle fractures in elderly patients.