Department of Trauma and Orthopaedics, Southmead Hospital, North Bristol Trust, Southmead Road, Bristol BS10 5NB, United Kingdom.
Department of Trauma and Orthopaedics, Southmead Hospital, North Bristol Trust, Southmead Road, Bristol BS10 5NB, United Kingdom.
Injury. 2022 Jun;53(6):2268-2273. doi: 10.1016/j.injury.2022.03.029. Epub 2022 Mar 16.
The aim of this study was to assess the outcomes of open lower limb fractures in patients aged 65 and over. The primary outcome was mortality at 30 days, and the secondary outcome was reoperation.
This study retrospectively identified patients aged 65 and over, presenting with an open tibia or ankle fracture, over a two-year period. Patient demographics, injury characteristics and surgical interventions were documented. The 30-day and one-year mortality was recorded, as well as any complications encountered.
There were 88 patients included in the study, with a mean age of 78 years and 66% of patients were female. Of this cohort, 67 patients (76%) had low energy injuries and 64 patients (73%) had Gustillo-Anderson type IIIB injuries. Treatment consisted of a one-stage surgical procedure in 49 patients (56%) and a two-stage procedure in 37 patients (42%), with two patients dying before definitive treatment. Primary wound closure was performed in 23 patients (26%), four patients (5%) had a split skin graft alone, 35 patients (40%) had local flaps, 21 patients (24%) were managed with free flaps and three patients (3%) had primary below knee amputations. The 30-day mortality rate was 10%, the one-year mortality rate was 19% and the reoperation rate was 8%.
Open lower limb fractures in the elderly are a life and limb threatening injury, with a similar demographic and mortality profile to hip fracture. This study demonstrates that limb salvage can be achieved in 93% of cases, with treatment performed as a one-stage procedure in 56% of cases.
本研究旨在评估 65 岁及以上患者开放性下肢骨折的治疗结果。主要结局指标为 30 天死亡率，次要结局指标为再次手术。
本研究回顾性纳入了 2 年内年龄在 65 岁及以上、患有开放性胫骨或踝关节骨折的患者。记录了患者的人口统计学、损伤特征和手术干预情况。记录了 30 天和 1 年的死亡率以及任何并发症。
共纳入 88 例患者，平均年龄为 78 岁，女性占 66%。该队列中，67 例（76%）患者为低能量损伤，64 例（73%）患者为 Gustillo-Anderson Ⅲ B 型损伤。治疗方法包括 49 例（56%）一期手术和 37 例（42%）二期手术，2 例患者在确定性治疗前死亡。23 例（26%）患者行一期伤口闭合，4 例（5%）患者单纯行皮片游离移植，35 例（40%）患者行局部皮瓣，21 例（24%）患者行游离皮瓣，3 例（3%）患者行初次膝下截肢。30 天死亡率为 10%，1 年死亡率为 19%，再次手术率为 8%。
老年人开放性下肢骨折是一种危及生命和肢体的损伤，其人口统计学特征和死亡率与髋部骨折相似。本研究表明，93%的病例可以实现肢体保留，56%的病例采用一期手术治疗。
