Treatment of unstable ankle fractures in the elderly – Should we perform osteosynthesis of osteoporotic bone?

Abstract

Abstracts / Injury Extra 43 (2013) 71–127 97 [2A.23]Treatment of unstable ankle fractures in the elderly – Shouldwe perform osteosynthesis of osteoporotic bone?K.S. Wronka ∗ , H. Salama, B. RameshGlan Clwyd Hospital, Rhyl, Wales, United KingdomBackground: Ankle fractures in the elderly with osteoporoticbones are often difficult to manage. There is an argument ofwhether we should treat such fractures conservatively, surgically,or even plan primary arthrodesis. Furthermore, there is risk of dif-ficult or failed fixation.Material and methods: The study was a retrospective evaluationof the management and follow up of 126 patients presented withdisplaced ankle fracture between 2001 and 2007. All patients wereabove 60 years at the time of injury.Results: Nearly 75% of our patients underwent open reductionand internal fixation (ORIF). The remaining had closed manipu-lation under anaesthesia (MUA) performed. Some patients hadmultiple co-morbidities including diabetes (14% of patients). Theresults of fixation were satisfactory. Early complications includedsuperficial wound infection (13% of patients), one chest infec-tion. There was no difference in diabetic patients. Metal workfailure occurred in one case only. Satisfactory union of fracturewas achieved in all patients. Only minority of patients developedchronic ankle pain (4%), no patient developed significant defor-mity. Amongst patients who underwent MUA, more than 22% hadchronic ankle pain. Significant ankle deformity was reported in 9%of patients, one patient required amputation of 5th foot ray due topressure sores due to cast and osteomyelitis.Conclusion: Our results show that accurate reduction and inter-nal fixation of ankle fracture in elderly patients is beneficial and oflower complication rates compared to MUA alone. The osteosyn-thesisfailureratewasverylowandpatientspentlesstimeinplasterand started physiotherapy earlier. Long term outcome was betterin group of patients who had ORIF.http://dx.doi.org/10.1016/j.injury.2012.07.272[2A.25]Ankle injury manipulation with or without X-ray! Is it time tochange the mindset?G. Hastie