Journal of Korean Foot and Ankle Society (대한족부족관절학회지)

Korean Foot & Ankle Society (대한족부족관절학회)
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Surgical Treatment of Ankle Fractures in the Elderly

고령 환자 족관절 골절의 수술적 치료

  • Choi, Jae-Yeol (Department of Orthopedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Jeong, Hwa-Jae (Department of Orthopedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Shin, Hun-Kyu (Department of Orthopedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Kim, Eugene (Department of Orthopedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Park, Se-Jin (Department of Orthopedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Seo, Dong-Seok (Department of Orthopedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine)
  • 최재열 (성균관대학교 의과대학 강북삼성병원 정형외과) ;
  • 정화재 (성균관대학교 의과대학 강북삼성병원 정형외과) ;
  • 신헌규 (성균관대학교 의과대학 강북삼성병원 정형외과) ;
  • 김유진 (성균관대학교 의과대학 강북삼성병원 정형외과) ;
  • 박세진 (성균관대학교 의과대학 강북삼성병원 정형외과) ;
  • 서동석 (성균관대학교 의과대학 강북삼성병원 정형외과)
  • Received : 2013.01.13
  • Accepted : 2013.02.14
  • Published : 2013.03.15
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Abstract

Purpose: The optimal management for ankle fracture in elderly patients remains controversial. This study was undertaken to review the results of surgical treatment of ankle fracture in the elderly and to compare with other studies. Materials and Methods: The participants in this study were 33 patients over the age of 65(average 71.5 years) who underwent surgical treatment of ankle fracture from January 2004 to December 2011. The study was a retrospective review of outcomes after open reduction and internal fixation (ORIF) of ankle fractures. To measure the clinical outcomes, we assessed postoperative complications, the pre- and post-operative mobility status, fracture union status, the time of fracture union and the AOFAS (American Orthopaedic Foot and Ankle Society) Ankle-Hindfoot scale. The level of patient satisfaction was also identified. Results: Delayed wound healing occurred in three patients(9.1%) but their wounds healed with repeated dressings without additional surgical treatment. Malunion occurred in one patient(3%). One patient(3%) had postoperative infection but healed with antibiotic treatment. 24 patients(96%) returned to preoperative mobility status. VAS score was lower than 2 in all patients. Bone union occurred with the 3.8 months (average months) after the surgery in all patients. Average AOFAS score was 87.4 and these were similar results as other studies of young patients. All patients were satisfied with surgical outcomes according to interviews. Conclusion: Surgical treatment of ankle fractures in the elderly can carry a significant risk of delayed wound healing and infection but incidence is relatively low. Internal fixation of ankle fractures in the elderly can be undertaken safely and the majority of patients can expect good outcome.

Keywords

References

  1. Kannus P, Palvanen M, Niemi S, Parkkari J, Jrvinen M. Increasing number and incidence of low-trauma ankle fractures in elderly people: Finnish statistics during 1970- 2000 and projection for the future. Bone. 2002; 31:430-3. https://doi.org/10.1016/S8756-3282(02)00832-3
  2. Mihai V, Sarah B, Sean D, et al. Displaced ankle fractures in the geriatric population: Operative or non-operative treatment. Foot and Ankle Int. 2007;13:10-4. https://doi.org/10.1016/j.fas.2006.06.004
  3. Beauchamp CG, Clay NR, Thaxton PW. Displaced ankle fractures in patients over 50 years of age. J Bone Joint Surg. 1983; 65:329-32.
  4. Greenfield DM, Eastell R. Risk factors for ankle fracture. Osteoporosis Int. 2001; 12:97-103. https://doi.org/10.1007/s001980170140
  5. Salai M, Dudkiweicz I, Novikov I, Amit Y, Chechick A. The epidemic of ankle fractures in the elderly - Is surgical treatment warranted? Arch Orthop Trauma Surg. 2000;120: 511-3. https://doi.org/10.1007/s004020000172
  6. Ali MS, McLaren CA, Rouholamin E, O'Connor BT. Ankle fractures in the elderly: nonoperative or operative treatment. J Orthop Trauma. 1987;1:275-80. https://doi.org/10.1097/00005131-198701040-00002
  7. Srinivasan CM, Moran CG. Internal fixation of ankle fractures in the very elderly. Injury. 2001;32:559-63. https://doi.org/10.1016/S0020-1383(01)00034-1
  8. Makwana MK, Bhowal B, Harper WM, Hui AW. Conservative versus operative treatment for displaced ankle fractures in patients over 55 years of age. A prospective, randomised study. J Bone Joint surg Br. 2001;83:525-9. https://doi.org/10.1302/0301-620X.83B4.11522
  9. Pagliaro AJ, Michelson JD, Mizel MS. Results of operative fixation of unstable ankle fractures in geriatric patients. Foot and Ankle Int. 2001;22:399-402. https://doi.org/10.1177/107110070102200507
  10. Strauss EJ, Egol KA. The management of ankle fractures in the elderly. Injury.2007;38:S2-S9. https://doi.org/10.1016/j.injury.2007.08.005
  11. Litchfield JC. The treatment of unstable fractures of the ankle in the elderly. Injury. 1987;18:128-32. https://doi.org/10.1016/0020-1383(87)90189-6
  12. Anand N, Klenerman L. Ankle fracture in the elderly: MUA versus ORIF. Injury. 1993;24:116-20. https://doi.org/10.1016/0020-1383(93)90202-H
  13. Leach WJ, Fordyce MJ. Audit of ankle fracture fixation in the elderly. J R Coll Surg Edinb. 1994;39:124-7.
  14. McCormack RG, Leith JM. Ankle fractures in diabetics. Complications of surgical management. J Bone Joint Surg Br. 1998;80:689-92. https://doi.org/10.1302/0301-620X.80B4.8648
  15. Bibbo C, Lin SS, Beam HA, Behrens FF. Complications of ankle fractures in diabetic patients. Orthop Clin North Am. 2001;32:113-33. https://doi.org/10.1016/S0030-5898(05)70198-X
  16. Park SW, Byun YS, Lee KS, Park JW, Lee SH. A clinical study of operative treatment for the ankle fractures. J Korean Fracture Soc. 1992;5:227-35. https://doi.org/10.12671/jksf.1992.5.2.227
  17. Song EK, Chung GH, Hong DY. A clinical analysis of open reduction of the ankle fracture. J Korean Fracture Soc. 1996;9:212-9. https://doi.org/10.12671/jksf.1996.9.1.212
  18. Jung HG, Yoo MK, You SJ, et al. The evaluation of clinical prognostic factors for the surgically treated unstable ankle fractures. J Korean Foot Ankle Soc. 2001;5:112-9.
  19. Lee KH, Moon CW, Kim YS, Kim HM, Jung SY. Clinical comparison of ankle fractures between the young and the elderly. J Korean Foot Ankle Soc. 2005;9:105-9.