Related Experiment Video
Updated: Oct 2, 2026
Treatment of Ankle Osteoarthritis with Total Ankle Replacement Through a Lateral Transfibular Approach
Published on: January 24, 2018
Management, reconstructive strategies and outcomes following open tibia/fibula and ankle fractures: An age-based
Xl Xinting Liu1, Co Christiana Odusanya2, Mf Mohammed Farid3
1Department of Plastic and Reconstructive Surgery, University Hospital North Midlands NHS Trust, Stoke on Trent, United Kingdom; Department of Plastic and Reconstructive Surgery, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2GW, United Kingdom.
Introduction:
Open lower limb fractures require multidisciplinary orthoplastic management. With an ageing population, older patients present with distinct injury patterns, greater comorbidity and reduced physiological reserve. In this study, we compared presentation, management and outcomes between younger and older patients.
Methods:
A 4-year retrospective complete case cohort study (2018-2022) was conducted at a tertiary major trauma centre. Adult patients with open tibia, fibula or ankle fractures were included. Patients were stratified into younger adult (<65 years) and older adult (≥65 years) cohorts based on age. Data collected included demographics, comorbidities, injury mechanism, Gustilo-Anderson (GA) classification, soft tissue reconstruction strategy, complications and mortality.
Results:
A total of 292 patients were included (183 younger and 109 older adults). The older cohort were predominantly female (71%) with greater comorbidity burden. Despite the predominantly low-energy mechanisms (61% ground level falls), they sustained more severe injuries, with a higher proportion of GA grade III fractures, particularly GA-IIIb (52%). Single-stage skeletal fixation and soft tissue coverage was more frequently performed in older patients (55%). Median length of stay was longer (16 vs 10 days), and complications were comparable (20 vs 14%). In-hospital mortality was observed exclusively in the older cohort and occurred in 10% of the population-nearly half of which resulted from acute preoperative physiological decompensation.
Conclusions:
Older patients experience higher morbidity alongside greater comorbidity and severity of injury, despite lower energy mechanism. Management of injury frequently favours single-stage soft tissue coverage. This highlights the need for patient centred orthoplastic pathways and importance of early multidisciplinary involvement.
