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Surgical fixation of unstable ankle fractures safe, reliable in elderly patients
One physician has found that patients older than 80 years recover well from surgical intervention.
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Operative fixation of unstable ankle fractures can be a safe, effective treatment for patients older than 80 years, allowing in many cases for a return to pre-injury levels of mobility, according to a recent study.
The findings were presented by Simon Platt, FRCS, at the 2010 Summer Meeting of the American Orthopaedic Foot and Ankle Society in National Harbor, Md, USA.
“We expect the elderly population — certainly those older than 80 years — to increase fivefold by the year 2050,” Platt said. “There is, however, little literature on the outcomes of ankle fracture fixation in this particular age group. It is thought that surgical intervention [in this group] means dealing with high infection rate, problems with failure of fixation and high levels of postoperative morbidity or mortality.”
A retrospective study
The study, conducted by Platt and colleagues, was a retrospective look at 92 consecutive patients — 80 women and 12 men — aged 80 years and older who underwent open reduction and internal fixation for unstable ankle fractures between January 1998 and August 2007.
Data were collected through case records and radiographs, and patients underwent a standard postoperative rehabilitation program. Complications were noted, and risk factors for poor prognosis were analyzed. Minimum follow-up for the study was 9 months.
Platt’s group found the most common fracture pattern to be pronation external rotation. He reported a superficial wound infection rate of 7% and a deep infection rate of 4%. Thirty-day postoperative mortality was 5.4% (5 patients). Platt noted that 75 (86%) of the remaining 87 patients were able to return to their pre-injury level of mobility by their last follow-up.
Risk factors
“We found some relevant risk factors … and these included diabetes, dementia, smoking and peripheral vascular disease,” Platt said. “If you had two or more risk factors, you had a five times higher increased risk of infection.”
The results run counter to the idea that surgical intervention for unstable ankle fractures in the very elderly should be avoided. Platt referred to his team’s findings as “very encouraging.”
“Surgical fixation of unstable ankle fractures in the very elderly — above 80-year-old — age group is safe, reliable and effective,” he concluded. “The majority of patients went back to previous levels of mobility.” – by Robert Press
Reference:
- Platt S, Shivarathre D, Chandran P. Operative fixation of unstable ankle fractures in patients aged over eighty years. Presented at the 2010 Summer Meeting of the American Orthopaedic Foot and Ankle Society. July 8-10, 2010. National Harbor, Md., USA.
- Simon Platt, FRCS, can be reached at simon.platt@whnt.nhs.uk.
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