OPERATIVE FIXATION OF UNSTABLE ANKLE FRACTURES IN PATIENTS AGED OVER EIGHTY YEARS

Abstract

Introduction: Operative fixation of unstable ankle fractures is a well recognised form of management. However controversy exists in the surgical treatment of unstable ankle fractures in the very elderly age group of over 80 years. Operative fixation in these cases is challenging and the postoperative mortality and morbidity has discouraged surgical intervention in this population. However, the literature regarding the prognosis of surgery in this elderly group is very limited. The purpose of our study was to describe the results of 85 patients aged above 80 years, who underwent operative fixation for unstable ankle fractures.

Methods: 92 consecutive patients aged above eighty years of age had open reduction and internal fixation for unstable ankle fractures during the period of January 1998 – August 2007. The data was collected retrospectively from the case records and radiographs. The mechanism of injury, fracture pattern, and medical co morbidities were recorded. A standard postoperative rehabilitation programme was followed. 5 patients were excluded as complete medical records were unavailable. The clinical and radiological outcomes following surgery were recorded and analysed in detail. The complications were noted and the risk factors for poor prognosis were analysed.

Results: There were 71 women and 16 men in the study. The most common fracture pattern was pronation external rotation type. The average age was 85.2 (Range 80.1 – 95.1 yrs). The minimum duration of follow up was 9 months. The superficial wound infection rate was 5.7% (5 cases) which settled with oral antibiotic treatment for 1–2 weeks. The deep infection rate was 4.6% (4 cases) which required surgical debridement and implant removal. The 30 day postoperative mortality was 4.6 % (4 cases). Most patients demonstrated radiological fracture union with medial malleolus possessing slightly a higher risk of non union. 88.1 % (74 out of 84 cases) were able to return back to their pre injury mobility at the last follow-up. Diabetes and smoking did not statistically influence the outcome of the surgery.

Conclusion: The results of operative fixation of unstable ankle fractures are very encouraging with good functional recovery and return to pre injury mobility status in most cases. The surgical fixation is technically challenging and careful attention must be given to the osteopenia and soft tissue factors.