Assessment of Recovery From Geriatric Ankle Fracture Using the Life Space Mobility Assessment (LSA)

Background: The Life Space Assessment (LSA) is a validated outcomes measure that aims to assess the level of mobility and physical functioning within one’s own environment following a medical event. We sought to study the recovery of geriatric ankle fracture patients utilizing the LSA. We hypothesized that the LSA would provide improved assessment of these patients and help identify key differences in operative and nonoperatively treated patients. Methods: Prospective observational study of geriatric patients age 65 years and older with an ankle fracture with 1-year follow-up. Operative versus nonoperative intervention was determined by the attending physician on a patient-specific basis. The LSA, Short Form–36 (SF-36), and visual analog pain scale (VAPS) were administered at predetermined intervals postinjury and scores were analyzed for significance. Results: 20 patients were enrolled in this study. 11 underwent surgery whereas 9 were treated nonoperatively. Regardless of treatment, the preinjury LSA score was 86.7. This significantly dropped to 20.6 at 6 weeks and recovered to 73.6 at 12 months. In the operative cohort, the LSA scores preinjury were 91.4 and improved to 87.6 after 1 year. The nonoperative group recorded 80.9 preinjury and only improved to 59.5 at 1 year ( P = 0.007). There was no statistically significant difference when comparing the results of the SF-36 and VAPS to the LSA. Conclusion: The LSA was effective in assessing recovery in geriatric ankle fracture patients. A severe deficit in mobility was seen for the first 6 months of recovery regardless of treatment. Operative patients ultimately returned to their baseline LSA at 1 year while nonoperative patients did not. Outcomes from the VAS and SF-36 mirrored the LSA but were not found to be statistically significant. Level of Evidence: Level II.

Assessment of Recovery From Geriatric Ankle Fracture Using The Life Space Mobility Assessment (LSA)

Category: Trauma Introduction/Purpose: Ankle fractures are the third most common type of fracture seen in the elderly population and recent work has suggested that operative intervention may provide improved outcomes. Current outcome measures do not accurately assess true mobility in the geriatric population. In this study, we utilize the Life Space Assessment (LSA), a novel medical assessment survey which focuses specifically on how a patient functions within his/her environment following a medical event. This tool has not been previously utilized in orthopedic patients. We postulated that the LSA would provide improved assessment of these patients and help identify key differences in operative and non-operatively treated patients when compared to current outcome measures. Methods: This study was designed as a prospective observational study in which all geriatric patients age 65 and older with an ankle fracture were followed for one year from the time they presented for treatment. Treatment options of either non- operative or operative were determined by the attending physician on a patient specific basis. The patient was invited to participate in the study at the initial injury visit. The LSA was administered at the initial visit and 6 weeks, 3 months, 6 months and 12 months post injury/surgery. The SF-36 and Visual Analogue Pain Scale surveys were administered at 6 months and 12 months as a comparison. Survey scores were tallied and standard means were determined for each time point. Statistical analyses were performed to determine significance. Results: 26 patients met inclusion criteria and 20 were enrolled. 11 underwent surgery while 9 were treated non-operatively. The surgical LSA group scored 91.4 pre-injury and improved to 87.6 after 1 year which was near baseline (Graph #1). The non-op group recorded 80.88 pre-injury and only improved to 59.5 at 1 year. For the VAS, surgical patients reported pain of 2.2 and 1.75 at 6 and 12 months. Non-op patients recorded pain of 2.25 and 2.4 at 6 and 12 months. For SF-36 physical score, surgical patients recorded 57.6 and 75.8 at 6 and 12 months while non-op patients scored 53.3 and 59.43. SF-36 mental scores for the surgical group was 60.63 and 74.83 while non-op patients recorded 76.88 and 86.5 at 6 and 12 months. Conclusion: Operative patients returned to their baseline LSA while non-operative patients continued to have lower mobility at one year. All patients’ mobility was significantly limited for first three months. Surgical patients had less pain at 12 months compared to non-op. Surgical patients showed significant improvement in SF-36 physical scores from 6 months to 1 year while non-op patients had minimal improvement echoing our findings from LSA. The operative group had improved outcomes compared to non-op and this is reflected in both their LSA and SF- 36 scores. Further investigations are needed to determine optimal treatment paradigm for geriatric ankle fracture patients.

Predictors of early complications following surgical treatment of geriatric ankle fracture

Category: Ankle, Diabetes, Trauma Introduction/Purpose: Factors predicting complications after surgical treatment of geriatric ankle fractures include presence of various comorbidities such as diabetes, chronic renal disease. However, beyond the binary definition of presence or absence, further speci? c information of these comorbidities such as their chronicity, severity and/or perioperative laboratories have not been studied as risk factors for postoperative complications. The purpose of this study is to investigate the association between the measurements of comorbidities and complications within the? rst 30 days following surgical treatment of geriatric ankle fracture. Methods: A retrospective cohort study. From 2000 to 2015, we collected patient demographics, comorbidities-related data including laboratory values and complications within 30 days following open reduction and internal fixation of low energy ankle fractures in patients older than 65 years. Multiple logistic regression analysis was performed to determine factors affecting minor (super? cial wound infection, delayed wound healing, urinary tract infection, pneumonia), major complications (deep wound infection, loss of? xation, deep venous thrombosis, organ/space failure). Results: In total, 1,358 patients were included for analysis. The average age was 70.54 years (SD, 7.40). There were 895 (66%) females and 463 (34%) males. Baseline glucose concentrations >200 mg/dL (p < 0.001) and the mean 48 hour postoperative serum glucose concentrations >150 mg/dL (p < 0.001), history of taking wound compromising medications (p = 0.003) were signi? cantly associated with minor complications. Preoperative glycated hemoglobin (HbA1c) >6.5% (p < 0.001), estimated glomerular? ltration rate (eGFR) <45 mL/min/1.73 m2 (p < 0.001), dependent functional status and presence of two or comorbidities (p < 0.001) were statistically associated with major complications. Conclusion: poor glycemic control in the perioperative period, wound-compromising medications were associated with increased rates of minor complications, whereas poor chronic glycemic control (HbA1c), decreased renal function and vulnerability with multiple comorbid conditions were associated with major complications. Perioperative blood glucose management may prevent minor complications, whereas and mean serum glucose concentrations of 150 mg/dL and higher during this time period