Ankle fratures in Erdely Patients with comorbidities: Treatment with

the augmentation technique

Mário Kuhn Adames

Gustavo Batista Birro

Rafael Silveira Basso

mkadames@uol.com.br

www.peflorianopolis.com.br

DISCLAMIER

My disclosure is in the Final AOFAS Program Book.

I have no potential conflicts with this presentation

INTRODUÇÃO

• There is a great controversy over the better treatment of ankle fractures in patients above 60 years1,2,3 ,, because the high rate of complications mainly in patients with systemic comorbidities4,5,6 A A A

OBJETIVO The purpose of this study was to evaluate the results on elderly patients with ankle fracture, operated by the augmentation technique

Ankle fratures in Erdely Patients with comorbidities: Treatment with the augmentation technique

MATERIAL • Period December 2006 to October

2010.

• 16 patients with ankle fracture and systemic comorbidities all 44 B or C of the AO-OTA system.

• Age: 61 and 88 years (Median 72 years)

• 10 patients were diabetics type II, 8 smokers, four had kidney disease, two patients had rheumatoid arthritis and six patients were chronic users of corticosteroid.

Ankle fratures in Erdely Patients with comorbidities: Treatment with the augmentation technique

MÉTODO • Augmentation fixation

(conventional fixation of fracture and increased syndesmosis fixation)4,

• Early mobilization and released full support with 8 weeks of PO

• The results were evaluated as the function, complications, reoperations number (return material or additional surgeries), re-hospitalization and mortality7,8.

Ankle fratures in Erdely Patients with comorbidities: Treatment with the augmentation technique

D D

RESULTADO Follow-up of 18 to 48

months (average of 28 months

Six superficial infections with improved with antibiotic and others two with skin necrosis that required skin graft.

None patient have lose of reduction or implant loosening that need reoperation

Ankle fratures in Erdely Patients with comorbidities: Treatment with the augmentation technique

RESULTADO 8 patients were removed the screws of

syndesmosis, in 5 patients were removed all the synthesis by loosening of screws.

The patients age doesn’t show difference on final results

All patients returned to walk and their daily activities.

Satisfaction: 15 (93.75%) are satisfied One was with restricted due to limitation of physical activity.

Four patients need new hospitalization due to uncontrolled diabetes and all patients are alive.

No patient by this time necessitated new fixing or Ankle arthrodesis

C

Ankle fratures in Erdely Patients with comorbidities: Treatment with the augmentation technique

CASE

Ankle fratures in Erdely Patients with comorbidities: Treatment with the augmentation technique

16m PO

C C

NNV, 82y, Female, DM Type II, oteoporotic bone 1) pre-op. 2) POI.,3) Skin Necrose 8 weeksPO. 4) Follow-up

A A A 1 2

3

8m PO 24m PO

4

NNV, 82Y, FemDM Type II, osteoporotic bone 1) pre-op. 2) POI., 3) Skin Necrosis w/8 weeks PO. 4) Follow-up

DISCUSSSÃO • Osteopenic bones exhibit high rates of complications when

undergoing conventional surgical techniques1,2,8, in the pursuit of improving the stabilities of fixation of these fractures were developed fixings blocked7, but these are not always accessible to your use, as well as features high cost, making it impossible for its use on a regular basis.

• The fixation with the technique of "augmentation" is presented in the literature as a low-cost and affordable option to your job, so is a stable mounting in osteopenic bone patients, slowing down the rate of complications4.

Ankle fratures in Erdely Patients with comorbidities: Treatment with the augmentation technique

DISCUSSSÃO • The method of fixation of the screw of the fibula to the

tibia can help improve rigidity, strength, stress, axial deformation and failure4,7, same facts are described when the use of additional anchorages in fractures of the ankle, which was demonstrated in our cases, presented tissue necrosis exposure and/or release of synthesis material but without the loss of fracture reduction until its consolidation, which is expressed by the return of our patients to their pre-injury levels activities.

Ankle fratures in Erdely Patients with comorbidities: Treatment with the augmentation technique

CONCLUSÃO

• The fixation of ankle fractures with the augmentation technique in patients above 60 years, bearers systemic comorbidities demonstrated safe and stable.

• It allows the mobilization and early weight bearing and progressive load, demonstrated by low rates of complications, as well as the patients ' satisfaction index of 93.75%.

Ankle fratures in Erdely Patients with comorbidities: Treatment with the augmentation technique

BYBLIOGRAFIC REFERENCE 1. Strauss EJ and Egol KA. The management of ankle fractures in the elderly. Int. J. Care Injury 2007;

(38S3): S2-S9. 2. Srinivasan CMS., Moran C G. Internal fixation of ankle fractures in the very elderly. Int. J. Care

Injured 2001; (32): 559–563 3. Pagliaro AJ., Michelson JD and MIzel MS. Results of Operative Fixation of Unstable Ankle

Fractures in Geriatric Patients. FAI 2001; 22(5): 399-402. 4. Dunn WR., Easley ME., Parks BG., et al. An Augmented Fixation Method for Distal Fibular Fracture

in Elderly Patients: A Biomechanical Evaluation. FAI 2004; 25(3): 128-131. 5. Flynn JM., Rodriguez-del Rio F. and Piza PA. Closed Ankle Fractures in Diabetic Patient. FAI 2000;

21(4): 311-319. 6. Leardini A., O`Connor JJ., Catani F et al. The Role of the Passive Structures in the Mobility and

Stability of the Human Ankle Joint: A Literature Review. FAI 2000; 21(7): 602-615. 7. Havi VK., Vallurupalli S and Morris R. Comparison of Augmentation Methods for Internal Fixation

of Osteoporotic Ankle Fractures. FAI 2009; 30(7): 696-703. 8. Houshian S., Bajaj SK., Mohammed AM. Salvage of osteoporotic ankle fractures after failed

primary fixation with an ankle arthrodesis nail: A report on four cases. Int. J Care Injuri: 2006; (37): 791-794.

Ankle fratures in Erdely Patients with comorbidities: Treatment with the augmentation technique