Internal fixation of ankle fractures in the very elderly

The management of ankle fracture in the elderly remains controversial. A review of the early results of open reduction and internal fixation (ORIF) in 74 patients over the age of 70 years (average 76 years) was undertaken to identify the early complications, length of stay, return to pre-injury mobility and residential status. This revealed 1% deep infection, 9% delayed wound healing, 5% malunion, and 3% mortality. In 12% of patients, soft bone and comminution precluded fixation of one malleolus. The average length of stay for patients who walked with Zimmer frame (116+/-65 days) before injury was significantly longer than those who walked independently or with sticks (19+/-15 days; P<0.01). The inability of the patients to weight-bear early led to lengthy hospital stays and difficult socio-economic problems. However, the majority (85%) of patients regained their pre-injury mobility and residential status. We conclude that ORIF of ankle fractures in the elderly carries a significant risk of wound edge necrosis with delayed wound healing but the incidence of deep infection is relatively low. Poor bone quality presents technical difficulties but the majority of patients can expect good outcome.