The AO triangular external fixator: a backup option in the treatment of ankle fractures in geriatric patients?
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ORIGINAL ARTICLE
The AO triangular external fixator: a backup option in the treatment of ankle fractures in geriatric patients? Robert Hennings1 · Ulrich J. Spiegl1 · Johannes K. M. Fakler1 · Annette B. Ahrberg1 Received: 18 April 2020 / Accepted: 14 July 2020 © The Author(s) 2020
Abstract Purpose To analyze the indications, radiological short-term outcomes, and complications of ankle fractures in geriatric patients treated with a triangular external fixator (AEF) until fracture healing. Furthermore, the effect of an additional osteosynthesis to AEF on the radiological outcome was investigated. Methods Retrospective analysis of ankle fractures treated in a Level I Trauma Center between 2005 and 2015 with an AEF in patients aged ≥ 65 years until fracture has healed. The combination of AEF and at least one additional osteosynthesis of a malleolus was defined as hybrid external fixator (HEF). At the time of AEF removal, a preserved ankle joint congruity was defined as good radiological outcome. Incongruity more than 2 mm was defined as poor radiologic results. Results 16 patients (13 women, 3 men) with a mean age of 74 years (SD 6.2) were treated with AEF until fracture healing, 9 with a single AEF and 7 with a HEF. Stabilization with HEF (n = 7 [100%]) showed higher rates of good radiological outcome than AEF alone (n = 4 [44%] of 9; p = 0.034). The duration of therapy did not differ between HEF and AEF (70 day vs 77 days). 4 patients (22%) required surgical revision. Conclusion It could be shown that osteosynthesis in addition to AEF leads to a better radiological short-term results than using AEF alone. Therefore, in the situation where an AEF is considered as the definitive treatment option for an ankle fracture in geriatric patients with expected or existing soft tissue problems, it should be done or completed as a HEF. Level of evidence Therapeutic level IV. Keywords Ankle · Minimal-invasive · Geriatric · Fracture · External fixator
Introduction Ankle fractures are some of the most common fractures in geriatric patients and studies show that the incidence is increasing [1]. In geriatric patients, the quality of the soft tissue and bone is often reduced, comorbidities are increased and the fracture morphology after low-energy trauma is often more complex [2–4]. Therefore, complications related to, for example, wound closure, infections, or secondary dislocation occur at a higher rate than in younger patients [5]. Thus, the indications for surgical or conservative treatment of polymorbid elderly patients have been the subject of controversial discussions in the past. In recent literature, there * Robert Hennings [email protected]‑leipzig.de 1
Department of Orthopaedics, Traumatology and Plastic Surgery, University of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
is a consensus that the surgical treatment of highly unstable fractures leads to better outcome and lower mortality [6–8]. The primary aim of performing an operation is to ensure full load-bearing capability at the earliest
