Management of displaced ankle fractures in elderly patients--is it worth performing osteosynthesis of osteoporotic bone?

BACKGROUND: Ankle fractures in the elderly with osteoporotic bones are often difficult to manage. It is debatable whether we should treat such fractures conservatively, surgically, or even plan primary arthrodesis. Furthermore, there is a risk of difficult or failed fixation.

MATERIAL AND METHODS: The study was a retrospective evaluation of the management and follow up of 126 patients presenting with displaced ankle fracture between 2001 and 2007. All patients were over 60 years old at the time of injury.

RESULTS: About 75% of our patients underwent open reduction and internal fixation (ORIF). The remaining had closed manipulation under anaesthesia (MUA) performed. Some patients had multiple co-morbidities including diabetes (14% of patients). The results of fixation were satisfactory. Early complications included superficial wound infection (13% of patients) and one chest infection. There was no difference in diabetic patients. Metalwork failure occurred in one case only. Satisfactory union of fracture was achieved in all patients. Amongst patients who underwent MUA, more than 22% had chronic ankle pain. Significant ankle deformity was reported in 9% of patients.

CONCLUSION: Our results show that accurate reduction and internal fixation of ankle fractures in elderly patients is beneficial and associated with lower complication rates compared to MUA alone. The osteosynthesis failure rate was very low and patients spent less time in plaster and started physiotherapy earlier.