Abstract
Background: Ankle fractures in the elderly with osteoporotic bones are often difficult to manage. The argument of whether we should treat such fractures surgically, conservatively or even plan primary arthrodesis is always there. Also, there is risk of difficult or failed fixation.
Patients and Methods: The study was a retrospective evaluation of the management and follow up of 126 patients presented with ankle fracture between 2001 and 2007. All patients were above 60 years at the time of injury and were treated whether conservatively or surgically.
Results: About 77% of our patients underwent open reduction and internal fixation (ORIF). The remaining had closed manipulation under anaesthesia (MUA) done. Some patients had multiple co-morbidities including diabetes (around 10%). The results of fixation were satisfactory. Early complications included superficial wound infection (13% of patients-all infections settled after conservative management with antibiotics and dressings), one chest infection. No difference in diabetic patients. Late complications include development of osteoarthritis (2%) and metal work loosening (2%). There were no reported ankle deformities and satisfactory union of fracture was achieved in all patients. Amongst patients who underwent MUA, more than 20% developed post traumatic osteoarthritis of ankle and 18% had chronic ankle pain. Ankle deformity was reported in 2 patients.
Conclusion: Our results show that accurate reduction and internal fixation of ankle fracture in the elderly is beneficial and of lower complication rates compared to MUA alone. The osteosynthesis failure rate was very low and patient spent less time in plaster and started physiotherapy earlier.
Correspondence should be addressed to BOSA at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE, England.
