School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0SP, UK.
Christ's College, St. Andrew's Street, Cambridge, CB2 3BU, UK.
Eur J Orthop Surg Traumatol. 2023 Jan;33(1):125-133. doi: 10.1007/s00590-021-03171-1. Epub 2021 Nov 24.
Fragility ankles fractures in the geriatric population are challenging to manage, due to fracture instability, soft tissue compromise, and patient co-morbidities. Traditional management options include open reduction internal fixation, or conservative treatment, both of which are fraught with high complication rates. We aimed to present functional outcomes of elderly patients with fragility ankle fractures treated with retrograde ankle fusion nails.
A retrospective observational study was performed on patients who underwent intramedullary nailing with a tibiotalocalcaneal nail. Twenty patients met the inclusion criteria of being over sixty and having multiple co-morbidities. Patient demographics, AO/OTA fracture classification, intra-operative and post-operative complications, time to mobilisation and union, AOFAS and Olerud-Molander scores, and patient mobility were recorded.
There were seven males and thirteen females, with a mean age of 77.82 years old, five of whom are type 2 diabetics. Thirteen patients returned to their pre-operative mobility state, and the average Charlson Co-morbidity Index (CCI) was 5.05. Patients with a low CCI are more likely to return to pre-operative mobility status (p = 0.16; OR = 4.00). All patients achieved radiographical union, taking on average between 92.5 days and 144.6 days. The mean post-operative AOFAS and Olerud-Molander scores were 53.0 and 50.9, respectively. There were four cases of superficial infection, four cases of broken or loose distal locking screws. There were no deep infections, periprosthetic fractures, nail breakages, or non-unions.
Tibiotalocalcaneal nailing is an effective and safe option for managing unstable ankle fractures in the elderly. This technique leads to lower complication rates and earlier mobilisation than traditional fixation methods.
老年人的脆性踝关节骨折难以处理，因为骨折不稳定、软组织受损和患者合并症多。传统的治疗方法包括切开复位内固定或保守治疗，但这两种方法都存在很高的并发症发生率。我们旨在介绍使用逆行踝关节融合钉治疗老年脆性踝关节骨折患者的功能结果。
对接受髓内钉治疗的患者进行回顾性观察性研究。符合纳入标准的 20 名患者年龄均在 60 岁以上且有多种合并症。记录患者的人口统计学、AO/OTA 骨折分类、术中及术后并发症、活动和愈合时间、AOFAS 和 Olerud-Molander 评分以及患者的活动能力。
有 7 名男性和 13 名女性，平均年龄为 77.82 岁，其中 5 人为 2 型糖尿病患者。13 名患者恢复到术前的活动状态，平均 Charlson 合并症指数（CCI）为 5.05。CCI 低的患者更有可能恢复到术前的活动状态（p=0.16；OR=4.00）。所有患者均达到影像学愈合，平均愈合时间为 92.5 至 144.6 天。术后 AOFAS 和 Olerud-Molander 评分平均分别为 53.0 和 50.9。有 4 例浅表感染，4 例断钉或松动的远端锁定螺钉。无深部感染、假体周围骨折、钉断裂或不愈合。
三踝骨折固定术是治疗老年人不稳定踝关节骨折的有效且安全的选择。与传统固定方法相比，该技术可降低并发症发生率并更早地活动。
