Department of Trauma and Orthopaedics, Southmead Hospital, Bristol, United Kingdom.
Department of Trauma and Orthopaedics, Southmead Hospital, Bristol, United Kingdom.
J Foot Ankle Surg. 2023 Sep-Oct;62(5):797-801. doi: 10.1053/j.jfas.2023.03.010. Epub 2023 Apr 20.
Elderly patients who sustain complex ankle or distal tibial fractures are often frail and comorbid and need surgery to contain the talus underneath the tibia in order to protect the soft tissue envelope and allow early unrestricted weightbearing. We performed a retrospective observational review of patients >65 years old who underwent a hindfoot nail fixation of an ankle or distal tibial fracture in our institution. Data collected included: injury sustained, open or closed injury, ASA grade, age at time of surgery, length of stay, postoperative mortality, complications, and further treatment. The primary outcome was reoperation. Secondary outcomes were infection and 1 year mortality. Seventy hind foot nailing procedures were undertaken. Sixty-three out of 70 patients were female. The average age of those who died within 1 year of surgery was 84 years. Forty-five out of 70 were open injuries. Eleven out of 70 patients died with 1 year of surgery (range 1-358 days postsurgery). Five out of 70 (7%) patients developed an infection. Four out of 5 of these injuries were open. Three out of 5 underwent removal of the nail due to infection. Two out of 5 had the infection suppressed with antibiotics. Ten out of 70 (14%) patients underwent locking bolt removal due to it backing out or being prominent and causing wound healing issues. Two out of 70 (3%) patients went on to have below knee amputations. Both were due to ongoing wound problems following open fractures. The hindfoot nail is an important implant when treating complex ankle and distal tibial fractures in an elderly population. It facilitates early mobilization to avoid deconditioning and other medical complications.
我们对在我院接受后足钉固定踝关节或胫骨远端骨折的>65 岁患者进行了回顾性观察性研究。收集的数据包括：损伤类型、开放性或闭合性损伤、ASA 分级、手术时的年龄、住院时间、术后死亡率、并发症和进一步治疗。主要结果是再次手术。次要结果是感染和 1 年死亡率。共进行了 70 例后足钉固定术。70 例患者中 63 例为女性。术后 1 年内死亡患者的平均年龄为 84 岁。45 例为开放性损伤。70 例患者中有 11 例在术后 1 年内死亡（术后 1-358 天）。70 例患者中有 5 例发生感染（7%）。其中 4 例为开放性损伤。由于感染，5 例中有 4 例需要取出钉子。5 例中有 2 例通过抗生素抑制了感染。70 例中有 10 例（14%）患者因锁定螺栓突出或松动导致伤口愈合问题而需要取出。70 例中有 2 例（3%）患者进行了膝下截肢。这两例均是由于开放性骨折后持续存在的伤口问题。在后足骨折的老年患者中，后足钉是治疗复杂踝关节和胫骨远端骨折的重要植入物。它可以促进早期活动，避免失健和其他医疗并发症。
