Langhit Kurar
University of Bristol, UK
Title: Clinical audit of ankle fracture management in the elderly
Biography
Biography: Langhit Kurar
Abstract
INTRODUCTION: Ankle fractures in the osteoporotic patient are challenging injuries to manage, due to a combination of poor soft tissue, peripheral vascular disease and increased bone fragility, often resulting in more complex fracture patterns. I aim to audit current practice and introduce change by producing recommendations to help improve long-term functional outcomes.
PATIENTS AND METHODS: A retrospective 3-week audit was conducted reviewing the results of ankle fracture management in 50 patients aged between 50-80 years. Patients admitted for either manipulation under anaesthesia (MUA)/application of the cast or open-reduction and internal fixation (ORIF) were considered. Medical notes, including discharge summaries were used for data extraction.
RESULTS: From the 50 patients included within the cohort, forty-two patients (84%) underwent surgical intervention, with eight patients (16%) managed non-operatively. Malunion (63%) and failed fracture fixation (25%) were more commonly reported in patients managed non-operatively. Surgery performed by trainee surgeons was unlikely to prolong theatre time with no statistical significance observed with the consultant led cohort (p=0.380). However, incidence of fracture malunion and failed fixation was significantly higher following surgery without consultant supervision in the junior trainee group (p=0.043).
CONCLUSIONS: Poor bone quality and associated co-morbidity can present technical difficulties when managing patients surgically. However, our results have shown considerably improved anatomical reduction rates following internal fixation in eligible patients, irrespective of age or gender.