Ankle fractures in the elder and old people
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Published:
May 2, 2019
Keywords:
Ankle fracture, elderly, functional reduction, biological reduction
Main Article Content
Abstract
Introduction: The World Health Organization defines elderly person as anyone who is between 75 and 90 years of age and those who surpass this age are called old people. The objective of this study was to analyze postoperative results of ankle fractures treated with MIPO and ORIF techniques, achieving a functional and biological reduction in patients older than 75 years.
Methods: Between 2013 and 2017, 13 patients beyond the age of 75 with unstable ankle fractures were evaluated. Six were treated with MIPO technique and 7 with ORIF. All patients were evaluated at 90 days and at 18 month postoperatively using the AOFAS score.
Results: Mean age was 79.7 years (range 75-95). Overall postoperative AOFAS score was 97 at day 90 and 96 at 18 months. No losses of reduction or shaft defects were observed.
Conclusion: Our study indicates that biological and functional reduction in patients older than 75 years is the ideal treatment for ankle fractures.
Methods: Between 2013 and 2017, 13 patients beyond the age of 75 with unstable ankle fractures were evaluated. Six were treated with MIPO technique and 7 with ORIF. All patients were evaluated at 90 days and at 18 month postoperatively using the AOFAS score.
Results: Mean age was 79.7 years (range 75-95). Overall postoperative AOFAS score was 97 at day 90 and 96 at 18 months. No losses of reduction or shaft defects were observed.
Conclusion: Our study indicates that biological and functional reduction in patients older than 75 years is the ideal treatment for ankle fractures.
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Arzac Ulla, R. I. (2019). Ankle fractures in the elder and old people. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 84(2), 129-135. https://doi.org/10.15417/issn.1852-7434.2019.84.2.897
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Clinical Research
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References
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2. Cole P, Craft J. Treatment of osteoporotic ankle fractures in the elderly: Surgical strategies. Orthopedics 2002;25(4):427-30. https://doi.org/10.3928/0147-7447-20020401-19
3. Urruela A, Egol K. Foot and ankle fractures in the elderly patient. Aging Health 2011;7(4):591-605. https://doi.org/10.2217/ahe.11.45
4. Pagliaro A, Michelson J, Misel M. Results of operative fixation of unstable ankle fractures in geriatric patients. Foot Ankle Int 2001;22(5):399-402. https://doi.org/10.1177/107110070102200507
5. Hughes JL, Weber H, Willenegger H, Kuner EH. Evaluation of ankle fractures: non-operative and operative treatment. Clin Orthop Rel Res1979;138:111-9. PMID: 445892
6. Milner B, Mercer D, Firoozbakhsh K, Larsen K, Decoster TA, Miller RA. Bicortical screw fixation of distal fibula fractures with a lateral plate: an anatomic and biomechanical study of a new technique. J Foot Ankle Surg 2007;46(5):341-7. https://doi.org/10.1053/j.jfas.2007.05.004
7. Minihane K, Lee C, Ahn C, Zhang LQ, Merk BR. Comparison of lateral locking plate and antiglide plate for fixation of distal fibular fractures in osteoporotic bone: a biomechanical study. J Orthop Trauma 2006;20(8):562-6. https://doi.org/10.1097/01.bot.0000245684.96775.82
8. Törnkvist H, Hearn TC, Schatzker J. The strength of plate fixation in relation to number and spacing of bone screws. J Orthop Trauma 1996;10(3):204-8. https://doi.org/10.1097/00005131-199604000- 00009
9. Yañez Arauz JM. Osteosíntesis mínimamente invasiva en fracturas del peroné distal. Rev Asoc Argent Ortop Traumatol 2005;70(2):136-45. http://www.aaot.org.ar/revista/2005/n2_vol70/art7.pdf
10. Yañez Arauz JM. Osteosíntesis mínimamente invasiva del maléolo peroneo. Tobillo y Pie 2012;1(2):37-46. [Sólo version impresa]
11. Collinge C, Sanders R, DiPasquale T. Treatment of complex tibial periarticular fractures using percutaneous techniques. Clin Orthop Relat Res 2000;375:69-77. https://journals.lww.com/clinorthop/Fulltext/2000/06000/Treatment_of_Complex_Tibial_Periarticular.9.aspx
12. Colvin AC, Walsh M, Koval KJ, McLaurin T, Tejwani N, Egol K. Return to sports following operatively treated ankle fractures. Foot Ankle Int 2009;30(4):292-6. https://doi.org/10.3113/FAI.2009.0292
13. Ruedi TP, Buckley RE, Morgan CG. AO Principles of fracture management. Pathophysiology, evaluation, and
classification of fractures. AO Foundation Publishing; 2007.
14. Bauer M, Bengner U, Johnell O, Redlund-Johnell I. Supination-eversion fractures of the ankle joint: Changes in incidence over 30 years. Foot Ankle 1987;8(1):26-8. https://doi.org/10.1177/107110078700800107
15. Davidovich R, Walsh M, Spitzer A, Egol KA. Functional outcome after operatively treated ankle fractures in the elderly. Foot Ankle Int 2009;30(8):728-33. https://doi.org/10.3113/FAI.2009.0728
16. Yañez Arauz J, Arzac Ulla R, Del Vecchio J, Eksarho A, Civetta L, Pérez Davila R. Osteosíntesis mininvasiva con placas bloqueadas en fracturas metafisarias distales de tibia. Comparación de resultados entre fracturas AO 43A y AO 43C. Rev Asoc Argent Ortop Traumatol 2015;80(3):185-95. http://www.scielo.org.ar/scielo.php?script=sci_
arttext&pid=S1852-74342015000300008&lng=es&nrm=iso&tlng=es
17. Lehtonen B, Jarvinen T, Honkonen S, Nyman M, Vihtonen K, Jarvinen M. Use of a cast compared with a functional ankle brace after operative treatment of an ankle fracture. A prospective, randomized study. J Bone Joint Surg Am 2003;85:205-11. https://jbjs.org/reader.php?source=The_Journal_of_Bone_and_Joint_Surgery/85/2/205/fulltext&id=21718&rsuite_id=833552&native=1#info
18. Fong W, Acevedo J, Stone R, Mizel M. The treatment of unstable ankle fractures in patients over eighty years of age. Foot Ankle Int 2007;28(12):1256-9. https://doi.org/10.3113/FAI.2007.1256
19. Srinivasan C, Moran C. Internal fixation of ankle fractures in the very elderly. Injury 2001;32:559-63. https://doi.org/10.1016/S0020-1383(01)00034-1
20. Guala A, Rial P, Tanoira I, Barla J, Sancineto C. Tratamiento de las fracturas de tobillo con placa LCP en pacientes mayores de 55 años. Resultados preliminares a mediano plazo. Rev Asoc Argent Ortop Traumatol 2007;80(1):48-54. http://www.aaot.org.ar/revista/2007/n1_vol72/art9.pdf
21. Salai, M, Dudkiewicz 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
2. Cole P, Craft J. Treatment of osteoporotic ankle fractures in the elderly: Surgical strategies. Orthopedics 2002;25(4):427-30. https://doi.org/10.3928/0147-7447-20020401-19
3. Urruela A, Egol K. Foot and ankle fractures in the elderly patient. Aging Health 2011;7(4):591-605. https://doi.org/10.2217/ahe.11.45
4. Pagliaro A, Michelson J, Misel M. Results of operative fixation of unstable ankle fractures in geriatric patients. Foot Ankle Int 2001;22(5):399-402. https://doi.org/10.1177/107110070102200507
5. Hughes JL, Weber H, Willenegger H, Kuner EH. Evaluation of ankle fractures: non-operative and operative treatment. Clin Orthop Rel Res1979;138:111-9. PMID: 445892
6. Milner B, Mercer D, Firoozbakhsh K, Larsen K, Decoster TA, Miller RA. Bicortical screw fixation of distal fibula fractures with a lateral plate: an anatomic and biomechanical study of a new technique. J Foot Ankle Surg 2007;46(5):341-7. https://doi.org/10.1053/j.jfas.2007.05.004
7. Minihane K, Lee C, Ahn C, Zhang LQ, Merk BR. Comparison of lateral locking plate and antiglide plate for fixation of distal fibular fractures in osteoporotic bone: a biomechanical study. J Orthop Trauma 2006;20(8):562-6. https://doi.org/10.1097/01.bot.0000245684.96775.82
8. Törnkvist H, Hearn TC, Schatzker J. The strength of plate fixation in relation to number and spacing of bone screws. J Orthop Trauma 1996;10(3):204-8. https://doi.org/10.1097/00005131-199604000- 00009
9. Yañez Arauz JM. Osteosíntesis mínimamente invasiva en fracturas del peroné distal. Rev Asoc Argent Ortop Traumatol 2005;70(2):136-45. http://www.aaot.org.ar/revista/2005/n2_vol70/art7.pdf
10. Yañez Arauz JM. Osteosíntesis mínimamente invasiva del maléolo peroneo. Tobillo y Pie 2012;1(2):37-46. [Sólo version impresa]
11. Collinge C, Sanders R, DiPasquale T. Treatment of complex tibial periarticular fractures using percutaneous techniques. Clin Orthop Relat Res 2000;375:69-77. https://journals.lww.com/clinorthop/Fulltext/2000/06000/Treatment_of_Complex_Tibial_Periarticular.9.aspx
12. Colvin AC, Walsh M, Koval KJ, McLaurin T, Tejwani N, Egol K. Return to sports following operatively treated ankle fractures. Foot Ankle Int 2009;30(4):292-6. https://doi.org/10.3113/FAI.2009.0292
13. Ruedi TP, Buckley RE, Morgan CG. AO Principles of fracture management. Pathophysiology, evaluation, and
classification of fractures. AO Foundation Publishing; 2007.
14. Bauer M, Bengner U, Johnell O, Redlund-Johnell I. Supination-eversion fractures of the ankle joint: Changes in incidence over 30 years. Foot Ankle 1987;8(1):26-8. https://doi.org/10.1177/107110078700800107
15. Davidovich R, Walsh M, Spitzer A, Egol KA. Functional outcome after operatively treated ankle fractures in the elderly. Foot Ankle Int 2009;30(8):728-33. https://doi.org/10.3113/FAI.2009.0728
16. Yañez Arauz J, Arzac Ulla R, Del Vecchio J, Eksarho A, Civetta L, Pérez Davila R. Osteosíntesis mininvasiva con placas bloqueadas en fracturas metafisarias distales de tibia. Comparación de resultados entre fracturas AO 43A y AO 43C. Rev Asoc Argent Ortop Traumatol 2015;80(3):185-95. http://www.scielo.org.ar/scielo.php?script=sci_
arttext&pid=S1852-74342015000300008&lng=es&nrm=iso&tlng=es
17. Lehtonen B, Jarvinen T, Honkonen S, Nyman M, Vihtonen K, Jarvinen M. Use of a cast compared with a functional ankle brace after operative treatment of an ankle fracture. A prospective, randomized study. J Bone Joint Surg Am 2003;85:205-11. https://jbjs.org/reader.php?source=The_Journal_of_Bone_and_Joint_Surgery/85/2/205/fulltext&id=21718&rsuite_id=833552&native=1#info
18. Fong W, Acevedo J, Stone R, Mizel M. The treatment of unstable ankle fractures in patients over eighty years of age. Foot Ankle Int 2007;28(12):1256-9. https://doi.org/10.3113/FAI.2007.1256
19. Srinivasan C, Moran C. Internal fixation of ankle fractures in the very elderly. Injury 2001;32:559-63. https://doi.org/10.1016/S0020-1383(01)00034-1
20. Guala A, Rial P, Tanoira I, Barla J, Sancineto C. Tratamiento de las fracturas de tobillo con placa LCP en pacientes mayores de 55 años. Resultados preliminares a mediano plazo. Rev Asoc Argent Ortop Traumatol 2007;80(1):48-54. http://www.aaot.org.ar/revista/2007/n1_vol72/art9.pdf
21. Salai, M, Dudkiewicz 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