LEVEL OF EVIDENCE: V, Expert opinion.Īnkle Autonomy Complications Elderly Failure Fracture fixation.Ĭopyright © 2021 Elsevier Masson SAS. 7) Is immediate protected weight bearing, with or without fixation, possible? This can be considered on a case-by-case basis depending on the extent of the trauma, patient compliance and treatment carried out. It is preferable to transplantar nailing. It is proposed to patients who are not very autonomous with a poor cutaneous status and/or severe osteoporosis. 6) Is immediate transarticular fixation with a retrograde or antegrade locked nail a reasonable option? Fixation can be done by retrograde nailing or antegrade nailing. External tibiocalcaneal fixation, alone or in combination, is a better option. 5) Does transplantar Steinmann pin fixation still have a role? It has few indications, limited to salvage situations (catastrophic local conditions, very poor general condition). However, the implantation rules must be followed exactly, and it is preferable to use thinner plates. 4) Is fixation with anatomical locking plates an advance? This is definitely an advance for these fragility fractures, which are often comminuted, as it allows return to weight bearing in certain conditions.
#Bimalleolar ankle fracture surgery skin#
The main risks are secondary displacement and skin lesions inside the cast, which are sources of infection. 3) Is there still a role for conservative treatment of displaced fractures? This will produce good results when it is well done however, the indications are rare and must be selected carefully. Definitive fixation is preferred if the skin status allows it, but one must keep temporary external fixation in mind as an option. Errors are not allowed in these patients, who are often fragile and in precarious health. The local conditions (skin and soft tissue damage) must be evaluated carefully as they determine the treatment. 2) When should a bimalleolar ankle fracture be treated surgically? The surgery must be done early, preferably within 8hours of the injury occurring, once the comorbidities have been controlled. This article will review this topic by answering 7 questions: 1) What are the distinctive features of elderly? Dependence on others, comorbidities, bone and soft tissue fragility are the main ones, explaining these high-risk situations and frequent complications. The benefit-risk balance of the various treatment options will be assessed with the main goal being that patients recover their autonomy. The treatment of bimalleolar ankle fractures in older adults requires rigorous analysis at all points, which starts by evaluating the cutaneous status and viability of the soft tissues upon admission. The functional prognosis is brought into play, along with the patient's life due to loss of autonomy and general complications occurring in patients who are bed-ridden. They can lead to complete loss of autonomy if the treatment is delayed and/or not adapted to the local conditions or the patient. Ankle injuries are particularly frequent in general traumatology but even more in geriatric traumatology.
Trauma in the geriatric population involves specific risks thus, the treatment must be adapted not only to the fracture, but to the local conditions and the patient.
Falls increase with age and because of certain medical conditions.
Musculoskeletal injuries are common in these patients, who can maintain their physical capacities and autonomy for a long time, but whose bone solidness is frequently reduced by osteoporosis. Geriatrics continues to evolve as a specialty by adapting itself to increasingly older patients.
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