San Francisco Bay Area Foot and Ankle Residency Program, Department of Orthopedics and Podiatric Surgery, Kaiser Permanente Medical Center, Oakland, CA 94118, USA.
Foot Ankle Surg. 2012 Jun;18(2):103-7. doi: 10.1016/j.fas.2011.03.010. Epub 2011 Apr 30.
Open reduction with internal fixation for unstable ankle fractures is relatively predictable with excellent outcomes. However, the management of ankle fractures in the elderly remains less predictable secondary to the various co-morbidities associated with advanced age.
A retrospective chart review of 216 patients over the age of 60 that sustained an ankle fracture, was performed to determine the incidence of complications after ORIF of ankle fractures in an elderly population in the perioperative course. Secondly, the incidence of complications in patients that had locking plate fixation compared to those that had non-locking plate fixation was determined. Lastly, the effect of early weight bearing on the incidence of complications was analyzed.
There was not a statistically significant difference in the complication rates between the group with co-morbidities (19.01%) and those without (11.96%). The postoperative complication with the highest incidence was wound dehiscence (9.7%), and only diabetes significantly predicted wound dehiscence. The fixation construct and weight-bearing protocol failed to significantly predict any of the indexed complications.
Overall, the results suggest that surgical treatment of unstable ankle fractures in the elderly is fairly predictable with an acceptable complication rate. The complication rates are higher with increased age and diabetes, but they failed to reach statistical significance. Conventional plating appears to provide adequate stability without increased risk of hardware failure. In addition patients that were allowed to walk within the first 2 weeks postoperatively did not experience a higher rate of hardware failure.
切开复位内固定治疗不稳定踝关节骨折的效果相对可预测，且预后良好。然而，由于与高龄相关的各种合并症，老年人踝关节骨折的治疗效果仍较难预测。
对 216 例年龄在 60 岁以上的踝关节骨折患者进行回顾性图表分析，以确定老年人群切开复位内固定术后围手术期骨折并发症的发生率。其次，比较锁定钢板固定与非锁定钢板固定患者的并发症发生率。最后，分析早期负重对并发症发生率的影响。
合并症组（19.01%）和无合并症组（11.96%）的并发症发生率无统计学差异。术后并发症发生率最高的是切口裂开（9.7%），只有糖尿病显著预测了切口裂开。固定结构和负重方案未能显著预测任何索引并发症。
总体而言，结果表明，老年不稳定踝关节骨折的手术治疗效果相当可预测，并发症发生率可接受。年龄增加和糖尿病会增加并发症的发生率，但未达到统计学意义。传统的钢板固定似乎提供了足够的稳定性，而不会增加硬件故障的风险。此外，术后 2 周内允许行走的患者并未出现更高的硬件故障发生率。
