scholarly journals Ankle fusion with tibiotalocalcaneal retrograde nail for fragility ankle fractures: outcomes at a major trauma centre

2021 ◽  
Author(s):  
Victor Lu ◽  
Maria Tennyson ◽  
James Zhang ◽  
Azeem Thahir ◽  
Andrew Zhou ◽  
...  
Keyword(s):  
The Elderly ◽  
Trauma Centre ◽  
Ankle Fractures ◽  
Complication Rates ◽  
Management Options ◽  
Superficial Infection ◽  
Geriatric Population ◽  
Ankle Fusion ◽  
Major Trauma Centre ◽  
Co Morbidity

Abstract Purpose 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. Methods 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. Results 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. Conclusion 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.

scholarly journals Ankle Fracture Complications in the Elderly

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0038
Author(s):  
Andrew Polk ◽  
Brian Buck ◽  
Michael Robertson ◽  
James Cook ◽  
Courtney Felton
Keyword(s):  
Geriatric Patient ◽  
Patient Population ◽  
Age Groups ◽  
Adverse Outcomes ◽  
Ankle Fractures ◽  
Complication Rates ◽  
Geriatric Population ◽  
Fracture Dislocations ◽  
Operative Fixation ◽  
Time From Injury

Category: Trauma Introduction/Purpose: In the geriatric patient population, pre-existing medical conditions and poor bone quality often make operative fixation of unstable ankle fractures and fracture-dislocations more challenging. The objective of this study was to characterize the complications that occurred following operative fixation of these injuries at our institution and to determine whether complication rates were higher in our geriatric patient population (65 years and older) as compared to our younger patient population. We hypothesized that complication rates in the geriatric population would be significantly higher relative to complication rates in the younger population. We also hypothesized that in elderly patients, the soft tissue envelope would be less forgiving and require significantly more time for swelling to decrease to a level considered appropriate for definitive surgical fixation to occur. Methods: With IRB approval, a review of medical records for patients diagnosed with ankle fractures or fracture-dislocations and operated on between January of 2015 and December of 2016 was performed. Major complications were defined as any adverse outcomes requiring further surgical intervention such as irrigation and debridement for infection or exposed hardware, nonunion, major hardware failure, or amputation. Minor complications included other adverse outcomes which did not require further surgical intervention such as wound dehiscence, loss of reduction, or delayed union. Data were compared for statistically significant (p<0.05) differences. Results: Medical record review produced 110 patients meeting criteria for inclusion with a mean follow-up of 179 days (range, 0 to 601 days). No significant (p>0.08) differences were noted in rates of major, minor, or total complications between geriatric and younger patients treated at our institution (Fig. 1). An analysis of patient characteristics, demonstrated a significantly (p=0.035) higher proportion of trimalleolar ankle fractures within the geriatric population, but the proportions of other injury types were not significantly (p>0.198) different between age groups. Prevalence of tobacco use, alcohol use, illicit drug use, or diabetes mellitus was not found to be significantly different (p>0.058) between age groups. No significant (p=0.12) difference was found in time from injury to definitive surgical treatment between age groups. Conclusion: Complication rates following operative treatment of ankle fractures and fracture-dislocations were not significantly higher in our geriatric patient population, although the incidence of minor complications in the geriatric population was markedly increased relative to the younger population. A lack of significant difference in time from injury to definitive surgical treatment between age groups suggests that geriatric patients may not require a prolonged time for soft tissue swelling to decrease prior to surgery. Further study with a larger sample size is needed to determine if these findings are clinically significant.

What predicts mortality in the elderly patient presenting as a trauma call? A report from a Major Trauma Centre

The Surgeon ◽  
2020 ◽  
Vol 18 (3) ◽  
pp. 142-149
Author(s):  
Christopher J. Lodge ◽  
Robert M. West ◽  
Peter Giannoudis ◽  
Theodoros H. Tosounidis
Keyword(s):  
Elderly Patient ◽  
Major Trauma ◽  
The Elderly ◽  
Trauma Centre ◽  
Major Trauma Centre

scholarly journals A health economic analysis of the management of open lower limb fractures in the elderly

2020 ◽  
Vol 30 (8) ◽  
pp. 1383-1391
Author(s):  
Caitlin Pley ◽  
Katie Purohit ◽  
Matija Krkovic ◽  
Ali Abdulkarim
Keyword(s):  
Lower Limb ◽  
The Elderly ◽  
Trauma Centre ◽  
Median Cost ◽  
Financial Loss ◽  
University Hospitals ◽  
Health Economic Analysis ◽  
Lower Limb Fractures ◽  
Major Trauma Centre ◽  
Limb Fractures

Abstract Aim The aim of this study was to investigate the financial implications of the inpatient management of open lower limb fractures in adults over 65 years old. Further, the study compares the calculated cost to the income received by the hospital for these patients and to the existing body of literature. Methods This study employed direct inpatient costing analysis to estimate the cost of treating the open lower limb fractures incurred by 58 patients over the age of 65 years treated in our centre (Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust) between March 2014 and March 2019. Results The median cost of inpatient care calculated in this study was £20,398 per patient, resulting in a financial loss to the hospital of £5113 per patient. When the results were disaggregated by sex, the median cost for an open lower limb fracture in a male patient was £20,886 compared to £19,304 in a female patient. Data were also disaggregated by the site of injury, which produced a median cost for an open femur fracture of £23,949, and £24,549 and £15,362 for open tibia and ankle fractures, respectively. Conclusion This study provides a valuable estimate of the expense of treating open lower limb fractures in patients over the age of 65 years in a Major Trauma Centre in England. The study highlights the large losses incurred by hospitals in treating these cases, and supports revision of the remuneration structures in the National Health Service to adequately cover their cost.

Differences in Injury Pattern and Mortality between Hong Kong Elderly and Younger Patients

2009 ◽  
Vol 16 (4) ◽  
pp. 224-232 ◽  
Author(s):  
CH Cheng ◽  
WT Yim ◽  
NK Cheung ◽  
JHH Yeung ◽  
CY Man ◽  
...  
Keyword(s):  
Hong Kong ◽  
Injury Severity ◽  
The Elderly ◽  
Mortality Rates ◽  
Trauma Centre ◽  
Elderly Group ◽  
Morbidity Rate ◽  
Trauma Patients ◽  
Younger Patients ◽  
Co Morbidity

Background The rapidly aging population in Hong Kong is causing an impact on our health care system. In Hong Kong, 16.5% of emergency department trauma patients are aged ≥65 years. Objective We aim to compare factors associated with trauma and differences in trauma mortality between elderly (≥65 years) and younger adult patients (15 to 64 years) in Hong Kong. Methods A retrospective observational study was performed using trauma registry data from the Prince of Wales Hospital, a 1200–bed acute hospital which is a regional trauma centre. Results A total of 2172 patients (331 [15.2%] elderly and 1841 [84.8%] younger) were included. Male patients predominated in the younger adult group but not in the elderly group. Compared with younger patients, elderly patients had more low falls and pedestrian-vehicle crashes and sustained injuries to the head, neck and extremities more frequently. The odds ratio (OR) for death following trauma was 5.5 in the elderly group (95% confidence interval [CI] 3.4–8.9, p>0.0001). Mortality rates increased progressively with age (p>0.0001) and were higher in the elderly at all levels of Injury Severity Score (ISS). Age ≥65 years independently predicted mortality (OR=5.7, 95% CI 3.5–9.3, p>0.0001). The elderly had a higher co-morbidity rate (58.6% vs. 14.1%; p>0.01). There was a lower proportion of trauma call activations for the elderly group (38.6% vs. 53.3%; p>0.01). Conclusion Elderly trauma patients differ from younger adult trauma patients in injury patterns, modes of presentation of significant injuries and mortality rates. In particular, the high mortality of elderly trauma requires renewed prevention efforts and aggressive trauma care to maximise the chance of survival.

scholarly journals Level of depression among elderly in selected old age homes at Mangalore, India

2015 ◽  
Vol 5 (1) ◽  
pp. 28-32 ◽  
Author(s):  
R Subba ◽  
H K Subba
Keyword(s):  
Old Age ◽  
Depression Scale ◽  
The Elderly ◽  
Family Type ◽  
Traumatic Experiences ◽  
Mild Depression ◽  
Major Life ◽  
Geriatric Population ◽  
Co Morbidity ◽  
Old Age Homes

Aging means so many things to so many individuals; it can be viewed as incorporating aspects of the biologic, social, psychologic, functional and spiritual domains. Throughout a person’s life, various traumatic experiences, either physical or emotional, may actually weaken the individual ability to repair or maintain himself/herself. Role changes, major life events and co morbidity contribute to an increased rate of depression in the geriatric population. A descriptive study was conducted to evaluate the level of depression among the elderly people. For this study, Purposive sampling was applied & 50 subjects were interviewed in selected old age homes by using a Modified Geriatric Depression Scale (GDS -15). The collected data were analyzed by descriptive and inferential statistics. The study findings showed that the overall mean for the depression among elderly was 6.42 with the SD of 3.21 and 38% of the elderly were suffering from mild depression where as 10% with severe depression. There was a significant association between the levels of depression and selected demographic variables such as gender, marital status, education level, family type, reasons to join old age homes & duration of stay except for age and religion. Helping older adults adjust to limitations, while accentuating positive attributes, may aid older people in remaining independent and may perpetuate a high quality of life during later years. Therefore, there is need to develop and plan the individualistic intervention to decrease depression level among elderly.DOI: http://dx.doi.org/10.3126/jcmc.v5i1.12568

scholarly journals Fibular nails for open and closed ankle fractures: Results from a non-designer level I major trauma centre

2019 ◽  
Vol 27 (1) ◽  
pp. 230949901983242 ◽  
Author(s):  
Bilal Al-Obaidi ◽  
Anatole Vilhelm Wiik ◽  
Rahul Bhattacharyya ◽  
Nadeem Mushtaq ◽  
Rajarshi Bhattacharya
Keyword(s):  
Major Trauma ◽  
Trauma Centre ◽  
Ankle Fractures ◽  
Major Trauma Centre ◽  
Level I

A comparison between the Major Trauma Centre management of complex open lower limb fractures in children and the elderly

Injury ◽  
2019 ◽  
Vol 50 (7) ◽  
pp. 1376-1381 ◽  
Author(s):  
Muhammad Faheem Khadim ◽  
Ahmed Emam ◽  
Thomas C. Wright ◽  
Thomas W.L. Chapman ◽  
Umraz Khan
Keyword(s):  
Lower Limb ◽  
Major Trauma ◽  
The Elderly ◽  
Trauma Centre ◽  
Lower Limb Fractures ◽  
Fractures In Children ◽  
Major Trauma Centre ◽  
Limb Fractures

Complications and mortality associated with olecranon fractures in the elderly: a retrospective cohort comparison from a large level one trauma centre

2021 ◽  
pp. 175857322199486
Author(s):  
J Parkes ◽  
R Limb ◽  
ST Quadri ◽  
JN Lamb ◽  
G Mohrir ◽  
...  
Keyword(s):  
Treatment Group ◽  
Treatment Options ◽  
The Elderly ◽  
Operative Management ◽  
Subsequent Treatment ◽  
Trauma Centre ◽  
Complication Rates ◽  
Wound Healing Problems ◽  
Large Level ◽  
Olecranon Fractures

Background Olecranon fractures in the elderly have an increasing incidence. This retrospective study aims to identify the complications and survivorship of these patients. Methods All patients >70 years old treated for an olecranon fracture at our institution were identified between 2007 and 2019. Loss of reduction and/or metalwork loosening was recorded. Also noted were wound healing problems, deep/superficial infections, and any subsequent treatment including return to surgery and/or removal of metalwork. Results From a total of 177 cases, 28 presented with concomitant fractures (16%), half of which were hip fractures. The largest treatment group underwent tension band wiring ( n = 82, 46%, mean age 80.8 yrs). Twenty-one of these suffered failure of fixation (26%), all requiring return to surgery. The second largest treatment group underwent plating ( n = 50 28%, mean age 80.1 yrs). Four of these suffered failure of fixation (8%), all requiring return to surgery. Forty-four patients were treated non-operatively (25%, mean age 83.8 yrs). Two patients suffered other complications (4.5%). Overall 1 year survivorship was 0.82. Discussion Olecranon fractures in the elderly have higher than expected 1 year mortality rates. Operative management results in high complication rates, often requiring return to surgery for metalwork problems. Significant consideration of treatment options is required in this cohort.

537 Open vs Closed Pilon Fractures: Comparison of Management, Outcomes, and Complications

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
V Lu ◽  
J Zhang ◽  
A Thahir ◽  
J A Lim ◽  
M Krkovic
Keyword(s):  
Treatment Algorithm ◽  
Open Fractures ◽  
Bone Union ◽  
Complication Rates ◽  
Post Injury ◽  
Aofas Score ◽  
Superficial Infection ◽  
Major Trauma Centre ◽  
Partial Weight ◽  
Pilon Fractures

Abstract Aim Despite the low incidence of pilon fractures, their high impact nature presents difficulties in surgical management/recovery. Current literature is varied, with no universal treatment algorithm. We aim to highlight differences in treatment, outcomes, complications between open and closed pilon fractures. Method This retrospective study was conducted at a major trauma centre, including patients over 5-year period. 135 patients were included (open:48, closed:87). Primary outcome was AOFAS score at 3-, 6- and 12-months post-injury. Secondary outcomes include time to partial weight-bear (PWB) and full weight-bear (FWB), bone union time, follow-up time. Post-operative complications were collected. Results Open fractures had lower AOFAS score 3 months post-injury, longer bone union time, and time to FWB. For both open and closed fractures, compared to ORIF patients, those treated with fine wire fixator (FWF) had lower AOFAS scores 3- and 6-months post-injury. Closed fracture patients treated with ORIF had shorter bone union time, time to PWB and FWB. Patients with AO/OTA 43A fractures needed shorter time to PWB and FWB than those with 43C fractures. Common complications (closed:open) were superficial infection (22%:54%), post-traumatic arthritis (25%:16%), non-union (11%:24%). Conclusions Open fractures, with more extensive soft tissue damage, were likely more suited for FWF, rather than ORIF (18% of open vs 72% of closed were treated with ORIF). Due to greater associated trauma, more frequent complications, and delayed definitive fixation, open fractures had lower AOFAS scores. Nevertheless, use of staged approach involving temporary external fixation, followed with ORIF or FWF achieved low complication rates and good functional recovery.

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