This article is more than 5 years old. Information may no longer be current.
Speaker: Obtain stable fixation of ankle fractures in osteoporotic patients
Click Here to Manage Email Alerts
NEW ORLEANS — In caring for osteoporotic patients with ankle factures, orthopedists should first address acute problems related to fracture before considering management approaches to obtain fracture healing and pain relief, according to a presenter at the American Academy of Orthopaedic Surgeons Annual Meeting.
“There are lots of techniques to manage these osteoporotic ankle fractures,” Samir Mehta, MD, who is in the Department of Orthopedic Surgery at the University of Pennsylvania, in Philadelphia, said.
Mehta participated in a session at the meeting on ankle fractures in patients with diabetes and severe osteoporosis.
He suggested physicians spend extra time on the workup for this group of patients. The goal of treatment is for the patient to resume activity as soon as possible, while avoiding complications, he said.
While conservative treatment mitigates the wound problems associated with surgery, issues can occur after a nonoperative ankle fracture reduction.
“Residual displacement could become problematic,” he said.
“That also means you have to be diligent with their cast management. [Their] soft tissue is no different than a diabetic’s soft tissue, so you have to be judicious with it,” Mehta said.
He also presented considerations for operative fixation in osteoporotic patients with ankle fractures.
“If you are going to use traditional implants, maybe a non-locking implant, think about the bone quality and if there is an indication for locked plating in this scenario,” Mehta said, adding that the method chosen for maintaining fixation is equally important.
Techniques that may find their place in these cases include tibial profibular screws that run from the fibula into the tibia to promote stability, posterolateral fibular plating and Kirschner wire cages, he said.
Mehta’s postoperative goal for these patients is to complete 2 weeks of non-weight-bearing. Then he advances them toward weight-bearing with a short-leg cast worn for 4 weeks to 8 weeks or at least until they are healed and without pain.
Mehta S. ICL #107. Ankle fractures: Osteoporotic fracture options. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 11-15, 2014; New Orleans.
Disclosure: Mehta has no relevant financial disclosures.