Ankle fracture surgery benefits elderly, younger patients equally

While function steadily improved for both groups, older patients improved at a slower rate, suggesting they may need more intensive rehabilitation.

CHICAGO — Surgical stabilization of unstable ankle fractures is as effective for elderly patients as for younger patients, according to a study by researchers in New York.

“Our data show those over 60 [years of age] do just as well clinically as younger people one year after surgery, with few complications,” said Kenneth A. Egol, MD, chief of the orthopedic trauma service at New York University Hospital for Joint Diseases. “However, self-reported functional results fall below that of patients younger than 60.”

Egol and colleagues at the university conducted the study. He discussed the results at a press conference here at the 73rd Annual Meeting of the American Academy of Orthopaedic Surgeons.

“We need to treat our elderly patients with ankle fractures the same as younger patients,” Egol said. “This study gives support to the current practice of aggressive treatment for unstable ankle fractures, so patients can return to their preinjury function.”

Surgical stabilization

Egol and colleagues reviewed outcomes for 369 patients — 313 patients aged less than 60 years and 56 patients aged 60 and older.

“The overall population had a similar breakdown as far as men and women. But when we get into the breakdown by age, our older patients are predominantly women, and that is a significant difference,” Egol said, noting the younger patient group included mostly men.

Despite differences in gender distribution between the age groups, there were no significant differences between the groups in terms of demographics, fracture types, and other characteristics, such as smoking and diabetes history.

All patients received similar surgical corrections and postoperative regimens. The latter involved six weeks of bracing and nonweight-bearing.

Significant improvements

Investigators found both patient groups had similar total scores for functional outcomes, including ability to perform daily activities, at three, six and 12 months follow-up.

Function steadily improved over one year in both groups, but to a lesser degree among the older patients, which indicates they may need more intensive rehabilitation, Egol noted.

“I do not read this as that at one year they are not as good as the younger patients. I read it as that at one year the older patients are doing about as well as the younger patients did at six months," Egol said. "So I think that for the older patients, it just takes a little longer to recover from the injury.”

Clinical scores showed no significant differences between the younger and older patient groups. Younger patients had a mean American Orthopaedic Foot and Ankle Society (AOFAS) score of 87 compared with a mean AOFAS score of 85 for the older patient group.

Egol noted that significantly more older patients did feel they were limited in daily activities at all follow-up points. But, “The older patient group reported less pain long-term than the younger group. However this difference was not significant,” he said.

Both groups had similar complication rates, he added.

For more information:
Davidovitch R, McLaurin TM, Tejwani NC, et al. Functional outcome after surgically treated ankle fractures: Does age matter? #489. Presented at the American Academy of Orthopaedic Surgeons 73rd Annual Meeting. March 22-26, 2006. Chicago.