Better is the foe of good: Outcome of operatively treated ankle fractures in the elderly. (September 2018)

• Record Type: Journal Article
• Authors: Rupp, Markus; Kockmann, Stefan; El Khassawna, Thaqif; Raschke, Michael J.; Heiss, Christian; Ochman, Sabine
• Is Part Of: Foot. Volume 36(2018)
• Page Start: 15
• Page End: 20
• Publication Date: 2018-09
• Subjects: Ankle -- Fracture -- Surgical treatment -- ORIF -- Elderly; Foot -- Diseases -- Periodicals; Foot -- Surgery -- Periodicals; Foot Diseases -- Periodicals; Foot -- surgery -- Periodicals; Pied -- Maladies -- Périodiques; Pied -- Chirurgie -- Périodiques; Pied -- Lésions et blessures -- Périodiques; Foot -- Diseases; Foot -- Surgery; Periodicals; Electronic journals; Electronic journals; 617.585005
• DOI: 10.1016/j.foot.2018.04.002
• Languages: English
• ISSNs: 0958-2592

Abstract

Highlights: Ankle fractures are the second most fractures of the lower limb (10.2%) after proximal femur fractures (11.2%). Standardized treatment protocols for unstable ankle fractures in the elderly do not exist. Treatment of ankle fractures in the elderly such as ORIF, close contact casting and primary hindfoot arthrodesis are controversially discussed. Long-time follow-up outcome of 48 and 49 months, respectively, after ORIF following AO treatment principles determined by the AOFAS score was 86.4 in patients aged 65 years or older vs. 92.4 in patients younger than 65 years, p < 0 . 05. Time to sufficient self-mobilization after ORIF in elderly patients (7.5 days) was almost five times longer than in patients younger than 65 years (1.6 days), p < 0.05, hospitalization in older patients was twice as long (16.4 days) as in younger patients (8.2 days), p < 0.05. Improved surgical treatment strategies should be developed to change early rehabilitation of elderly patients to the better. Abstract: Background: Ankle fractures are the second most common fractures of the lower extremities. Nonetheless, no standardized treatment protocol for unstable ankle fractures of the elderly exists today. Choices to treat ankle fractures are debated controversially, including (1) conservative treatment, (2) open reduction and internal fixation (ORIF), and (3) primary hind-foot arthrodesis. This retrospective study aimed to examine the healing result in patients treated by ORIF after unstable ankle fractures. Methods: The study was designed as a retrospective comparative series. The American Orthopaedic Foot and Ankle Society (AOFAS) score was followed to assess the postsurgical outcome. Data was obtained from 66 patients younger than 65 (median age, 42 years; range, 18–63) and 28 patients aged 65 or older (median age, 71 years; range, 65–81). The mean follow-up period for the younger-than-65 group was 48 months; for patients older than 65, it was 49 months. Results: An AOFAS score of 86.4 in the older and 92.4 in the younger group was determined, p -value < 0.05. Elderly patients suffered from significantly more open-ankle fractures and comorbidities than the younger group did, p -value < 0.05 each. The duration of hospital stay and the time needed to reach sufficient self-mobilization were both significantly different between the two groups, p -value < 0.05. Conclusion: ORIF treatment of ankle fractures resulted in good functional assessment after a mean follow-up of 49 months in the elderly. Pre-fracture health condition positively affected the healing results in younger patients. This study confirms the basic AO Foundation principles for good postsurgical results. Level of evidence : Level III, retrospective comparative series.