Clinical and Radiological Result of Ankle Fractures Matching Surgical Criteria in Elderly Patients
Introduction: Ankle fractures are common in the elderly, ranking third after hip and wrist fractures. Elderly patients with ankle fractures often have multiple comorbidities, which can impact treatment outcomes and increase the risk of complications. Prompt recovery is important to preserve their independence. Currently, there are no definitive recommendations favoring one treatment approach over another. Currently, there are no strong recommendations advocating for better results with one treatment over another. Materials and Methods: In a retrospective study, ankle fractures requiring surgery between September 2015 and September 2021 in patients over 70 years old were analyzed. Radiographic parameters, demographics, comorbidities, BMI, and complications were assessed. Fractures were classified based on AO/OTA, Weber, and Lauge-Hansen classifications. Functional outcomes were analyzed using the OMAS (Olerud Molander Ankle Score) scale. Results: The study included 71 patients, with an average age of 76.54 years. 60% were female(n=43). The average follow-up was 14 months (range 8-17). The most common fracture pattern was Supination-External Rotation (60 cases, 84.5%). Among them, 90% were classified as Weber B(n=64). 21 patients had a fracture-dislocation. Closed reduction with a cast boot was initially performed, until achieving satisfactory reduction, followed by definitive orthopedic management or surgical treatment in 25 and 46 patients, respectively. The most frequently used surgical treatment was open reduction and internal fixation (ORIF) with a low-profile plate on the fibula and a cannulated screw on the medial malleolus (93% cases). The conservative management group had a complication rate of 36%, but no surgical interventions were required. The surgical management group had a complication rate of 23.9%, including wound complications and hardware intolerance, with a reintervention rate of 20%. There was no increased risk of complications or reinterventions based on diabetes, overweight, or age stratification. The average OMAS score did not significantly differ between the surgical and conservative groups. Conclusion: The treatment of ankle fractures in geriatric patients remains controversial. Conservative management with a cast boot after proper reduction yields favorable functional outcomes with minimal complications. Surgical management using conventional techniques has a higher rate of soft tissue complications, suggesting the need for less aggressive approaches to achieve better biological synthesis.
