Treatment of ankle fractures in geriatric patients

To review different treatment options for elderly patients with ankle fractures and choose the most appropriate surgical treatment strategy for this group of patients Patients, with ankle fractures (AO/OTA fracture classification- 44), which were treated in Hospital of Traumatology and Orthopaedics, Riga, Latvia in period from 2016 to 2019 were identified. All patients older than 69 years of age were included. Radiological examinations and medical documentation were analyzed. In the period of year 2016 to 2019 1013 patients with different pattern ankle fractures were treated in Hospital of Traumatology and Orthopaedics. 96 (9,47 %) patients were eligible for the study. Fracture of lateral, medial and posterior malleolus (back part of the tibia) (AO/OTA fracture classification- 44B3.2, 44B3.3, 44C1.3, 44C2.3, 44C3.3) were the most common type of injury (69,79%). Conservative treatment were used for 11                 (11,46 %) patients. The main indications for conservative treatment were bedridden patients, atherosclerotic injury of arteries with extremity ischemia. Percutaneous transarticular ankle joint fixation with Kirschner wires were used for 5 (5,21 %) patients. Internal fixation methods were used in rest cases (83,33 %). The incidence of ankle fracture in geriatric patient slowly increases with time. The most common type of injury is trimalleolar fracture, that is highly unstable, with distal tibiofibular syndesmosis injury- conservative treatment in such cases leads to significantly inferior outcomes. Indications for operative treatment in geriatric patients should not differ from those in younger patients. Performing internal fixation, surgeon must try to make stable osteosynthesis with maximal soft tissue preservation. Surgeons should avoid performing unstable fixation, for example, transarticular ankle joint fixation with Kirschner wires, that increase risk of complication.