Ankle fractures in the elderly: Treatment and results in 477 patients

IntroductionIn the elderly, ankle fractures are likely to cause specific complications and have a major impact on their autonomy. The goal of this multicentre study was to assess these outcomes in a geriatric population treated operatively.Material and methodsThis retrospective study included 477 patients with ankle fractures treated surgically between 2008 and 2014. The minimum age was 60 years for women and 70 for men. Patients with a tibial pilon fracture or less than 3 months’ follow-up were excluded. Functional (autonomy and comorbidities) and radiological assessments were performed before surgery and at the review.ResultsThe cohort was 81% female (384 women, 93 men) and had median age of 74 years. The preoperative autonomy was 7.8 points on average using the Parker score. Most of the fractures were either Weber type B (n = 336) or type C (n = 114). At the follow-up, the mean autonomy score was 7.3 points. The fibula was fixed with a plate and screws in 69% of cases (n = 325), with additional internal malleolar fixation was carried out in some cases. A satisfactory result, defined as 2 points or less reduction in the Parker score, was found in 89.9% of patients; 71.8% had not lost any autonomy. The main risk factors for loss of autonomy were being more than 80 years of age (OR = 2.93, P < 0.001), poor surgical reduction (OR = 2.8, P < 0.01), the presence of two or more comorbidities (OR = 2.71, P < 0.001), being female (OR = 2.19, P < 0.043) or having a Weber type C fracture (OR = 2.05, P = 0.023).DiscussionThe functional results are satisfactory overall following standard surgical treatment consisting of internal malleolar and fibular fixation for ankle fractures in the elderly. We identified five factors that greatly impact functional recovery.Level of evidenceIV.