Percutaneous Treatment of Geriatric Distal Tibia and Fibula Fractures With a Poor Soft Tissue Envelope - A Case...

Geriatric distal tibia and fibula fractures are typically treated with open reduction and internal fixation (ORIF) or prolonged cast immobilisation. These methods predispose to wound complications and delayed weight-bearing. Percutaneous fixation can offer a stable construct allowing for early weight-bearing while minimising wound complications. This case series details the management and outcomes of patients over 65 with distal tibia and fibula fractures and poor soft tissue envelope treated with percutaneous fixation.

A prospective observational study was conducted at two Victorian orthopaedic units, identifying patients over 65 years of age who underwent percutaneous distal tibia or fibula fracture fixation. Patient selection considered soft tissue quality and overall health. Antegrade tibial intramedullary nails and retrograde percutaneous screws were used. Surgery proceeded without delay for swelling or anticoagulation cessation. Clinical notes and radiographs were analysed for premorbid health, mobility status, injury mechanism and classification, fixation methods, post-operative mobility, and treatment complications.

The study identified 13 ankles in 11 patients (average age 82) across two sites. Fractures included 4 trimalleolar, 5 bimalleolar, 1 lateral malleolar, and 3 distal tibia and fibula diaphyseal. Three fractures were open. Median time to operation was 3 days. Six patients were allowed immediate weight-bearing as tolerated. Median post-operative stay was 5 days. One deep infection required removal of a suture-button syndesmosis device and two minor wound breakdowns (distant to surgical site) were managed non-operatively with dressings.

Percutaneous distal tibia and fibula fracture fixation appears to be a viable alternative to ORIF in geriatric patients with poor soft tissue envelope, potentially offering reduced complications and earlier mobilisation.

Level IV.