Kadakia Rishin J, Ahearn Briggs M, Schwartz Andrew M, Tenenbaum Shay, Bariteau Jason T
Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA,
Department of Orthopedic Surgery, Chaim Sheba Medical Center at Tel Hashomer, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Orthop Res Rev. 2017 May 29;9:45-50. doi: 10.2147/ORR.S112684. eCollection 2017.
Ankle fractures are the third most common osseous injury in the elderly, behind hip and distal radius fractures. While there is a rich history of clinical advancement in the timing, technique, perioperative management, and associated risks of hip fractures, similar evaluations are only more recently being undertaken for ankle fractures. Traditionally, elderly patients were treated more conservatively; however, nonoperative management has been found to be associated with increased mortality. As such, older and less healthy patients have become operative candidates. The benefits of geriatric/orthopedic inpatient comanagement that have been well elucidated in the hip fracture literature also seem to improve outcomes in elderly patients with ankle fractures. One of the orthopedist's roles is to recognize the complexities of osteoporotic bone fixation and optimize wound healing potential. Though the immediate cost of this surgical approach is inevitably higher, the ultimate cost of long-term care has been found to be substantially reduced. It is important to consider the mortality and morbidity benefits and cost reductions of operative intervention and proper inpatient care of geriatric ankle fractures when they present to the emergency department or the office.
踝关节骨折是老年人中第三常见的骨性损伤，仅次于髋部骨折和桡骨远端骨折。虽然在髋部骨折的治疗时机、技术、围手术期管理及相关风险方面有着丰富的临床进展历史，但对踝关节骨折的类似评估直到最近才开展。传统上，老年患者接受更为保守的治疗；然而，已发现非手术治疗与死亡率增加相关。因此，年龄较大且健康状况较差的患者已成为手术候选对象。在髋部骨折文献中已充分阐明的老年病科/骨科住院联合管理的益处，似乎也能改善老年踝关节骨折患者的治疗效果。骨科医生的职责之一是认识到骨质疏松性骨固定的复杂性，并优化伤口愈合潜力。尽管这种手术方法的直接成本不可避免地更高，但已发现长期护理的最终成本大幅降低。当老年踝关节骨折患者出现在急诊科或诊室时，考虑手术干预以及对其进行恰当住院治疗所带来的死亡率和发病率益处及成本降低是很重要的。
