Short Term Complications in Geriatric Ankle Fractures Using a Protocolized Approach to Surgical Treatment: Is Early Weight Bearing Safe?

Overview

Journal Iowa Orthop J

Specialty Orthopedics

Date 2020 Aug 4

PMID 32742225

Citations 1

Authors

Gerard Chang

Tyler Henry

Keenan Sobol

James Krieg

Affiliations

Soon will be listed here.

Abstract

Background: Surgical management of geriatric ankle fractures requires unique considerations in addressing operative risks. Prior studies have reached varying conclusions regarding optimal treatment strategies. The primary aim of this study was to determine if surgical fixation following a predetermined treatment protocol was safe and effective. The secondary aim was to determine if immediate weight bearing as tolerated (IWBAT) in a subset of patients was safe or conferred any short-term benefits.

Methods: This retrospective study included all patients over the age 65 treated surgically for an ankle fracture by a single surgeon over a five-year period. A protocol was used including: augmented fixation techniques, IWBAT for select patients, and specific strategies to minimize soft tissue damage. Complications associated with operative treatment were analyzed. A subgroup analysis of patients with isolated ankle injuries was carried out to compare patients made IWBAT to patients made non-weight bearing (NWB) postoperatively.

Results: Thirty-four patients were included in the study. Fracture types were predominantly OTA 44B2 (18/34, 53%) and 44B3 (8/34, 24%). Union rate was 100%. Augmented fixation techniques were used in 14/34, 41% of patients. Twenty-one of 34, 62% of patients were allowed IWBAT. There were 4 complications, 12%: 1 malunion, 1 superficial infection, and 2 wound dehiscence. Two patients returned to the operating room for removal of hardware and irrigation and debridement. In the subgroup analysis, the IWBAT group was discharged to a rehabilitation facility at a significantly lower rate than the NWB group, 25% (4/16) vs 90% (9/10; p=0.0036). There were no differences in the complication rates between the two groups.

Conclusion: Acceptable outcomes can be reliably obtained when following a standardized approach to geriatric ankle fracture management. In addition, immediate weight bearing in select patients does not seem to increase complications and may benefit patients by increasing rate of discharge to home..

Citing Articles

Weightbearing in Select Geriatric Ankle Fractures Following Open Reduction Internal Fixation: Short Scientific Report.

Coscia A, Jandzinski M, Talusan P, Ahn J Foot Ankle Orthop. 2025; 10(1):24730114241310413.

PMID: 39822190 PMC: 11736757. DOI: 10.1177/24730114241310413.

Early Unprotected Weight Bearing and Pre-Scheduled Supervised Rehabilitation Program after Surgical Treatment of Ankle Fractures.

Gungor H, Buker N, Savkin R, Ok N Arch Bone Jt Surg. 2022; 10(2):183-189.

PMID: 35655737 PMC: 9117903. DOI: 10.22038/ABJS.2021.55767.2777.

References

Siu A, Penrod J, Boockvar K, Koval K, Strauss E, Morrison R . Early ambulation after hip fracture: effects on function and mortality. Arch Intern Med. 2006; 166(7):766-71. PMC: 3045760. DOI: 10.1001/archinte.166.7.766. View

Strauss E, Egol K . The management of ankle fractures in the elderly. Injury. 2007; 38 Suppl 3:S2-9. DOI: 10.1016/j.injury.2007.08.005. View

Firoozabadi R, Harnden E, Krieg J . Immediate weight-bearing after ankle fracture fixation. Adv Orthop. 2015; 2015:491976. PMC: 4345246. DOI: 10.1155/2015/491976. View

Minihane K, Lee C, Ahn C, Zhang L, Merk B . 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. DOI: 10.1097/01.bot.0000245684.96775.82. View

Makwana N, Bhowal B, Harper W, Hui A . 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(4):525-9. DOI: 10.1302/0301-620x.83b4.11522. View

Kadakia R, Ahearn B, Tenenbaum S, Bariteau J . Costs Associated With Geriatric Ankle Fractures. Foot Ankle Spec. 2016; 10(1):26-30. DOI: 10.1177/1938640016666919. View

Kadakia R, Hsu R, Hayda R, Lee Y, Bariteau J . Evaluation of one-year mortality after geriatric ankle fractures in patients admitted to nursing homes. Injury. 2015; 46(10):2010-5. DOI: 10.1016/j.injury.2015.05.020. View

Anderson S, Li X, Franklin P, Wixted J . Ankle fractures in the elderly: initial and long-term outcomes. Foot Ankle Int. 2009; 29(12):1184-8. DOI: 10.3113/FAI.2008.1184. View

Olsen J, Hunter J, Baumhauer J . Osteoporotic ankle fractures. Orthop Clin North Am. 2013; 44(2):225-41. DOI: 10.1016/j.ocl.2013.01.010. View

10.

Pagliaro A, Michelson J, Mizel M . Results of operative fixation of unstable ankle fractures in geriatric patients. Foot Ankle Int. 2001; 22(5):399-402. DOI: 10.1177/107110070102200507. View

11.

Miller A, Margules A, Raikin S . Risk factors for wound complications after ankle fracture surgery. J Bone Joint Surg Am. 2012; 94(22):2047-52. DOI: 10.2106/JBJS.K.01088. View

12.

Kristensen M, Kehlet H . The basic mobility status upon acute hospital discharge is an independent risk factor for mortality up to 5 years after hip fracture surgery. Acta Orthop. 2017; 89(1):47-52. PMC: 5810832. DOI: 10.1080/17453674.2017.1382038. View

13.

Kammerlander C, Pfeufer D, Lisitano L, Mehaffey S, Bocker W, Neuerburg C . Inability of Older Adult Patients with Hip Fracture to Maintain Postoperative Weight-Bearing Restrictions. J Bone Joint Surg Am. 2018; 100(11):936-941. DOI: 10.2106/JBJS.17.01222. View

14.

Cavo M, Fox J, Markert R, Laughlin R . Association Between Diabetes, Obesity, and Short-Term Outcomes Among Patients Surgically Treated for Ankle Fracture. J Bone Joint Surg Am. 2015; 97(12):987-94. DOI: 10.2106/JBJS.N.00789. View

15.

Sigurdsson E, Siggeirsdottir K, Jonsson Jr H, Gudnason V, Matthiasson T, Jonsson B . Early discharge and home intervention reduces unit costs after total hip replacement: results of a cost analysis in a randomized study. Int J Health Care Finance Econ. 2008; 8(3):181-92. DOI: 10.1007/s10754-008-9036-0. View

16.

Rammelt S . Management of ankle fractures in the elderly. EFORT Open Rev. 2017; 1(5):239-246. PMC: 5367590. DOI: 10.1302/2058-5241.1.000023. View

17.

Beauchamp C, Clay N, Thexton P . Displaced ankle fractures in patients over 50 years of age. J Bone Joint Surg Br. 1983; 65(3):329-32. DOI: 10.1302/0301-620X.65B3.6404905. View

18.

Srinivasan C, Moran C . Internal fixation of ankle fractures in the very elderly. Injury. 2001; 32(7):559-63. DOI: 10.1016/s0020-1383(01)00034-1. View

19.

Looker A, Borrud L, Hughes J, Fan B, Shepherd J, Sherman M . Total body bone area, bone mineral content, and bone mineral density for individuals aged 8 years and over: United States, 1999-2006. Vital Health Stat 11. 2014; (253):1-78. View

20.

Oldmeadow L, Edwards E, Kimmel L, Kipen E, Robertson V, Bailey M . No rest for the wounded: early ambulation after hip surgery accelerates recovery. ANZ J Surg. 2006; 76(7):607-11. DOI: 10.1111/j.1445-2197.2006.03786.x. View