Abstract：
Elderly patients who sustain complex ankle or distal tibial fractures are often frail and comorbid and need surgery to contain the talus underneath the tibia in order to protect the soft tissue envelope and allow early unrestricted weightbearing. We performed a retrospective observational review of patients >65 years old who underwent a hindfoot nail fixation of an ankle or distal tibial fracture in our institution. Data collected included: injury sustained, open or closed injury, ASA grade, age at time of surgery, length of stay, postoperative mortality, complications, and further treatment. The primary outcome was reoperation. Secondary outcomes were infection and 1 year mortality. Seventy hind foot nailing procedures were undertaken. Sixty-three out of 70 patients were female. The average age of those who died within 1 year of surgery was 84 years. Forty-five out of 70 were open injuries. Eleven out of 70 patients died with 1 year of surgery (range 1-358 days postsurgery). Five out of 70 (7%) patients developed an infection. Four out of 5 of these injuries were open. Three out of 5 underwent removal of the nail due to infection. Two out of 5 had the infection suppressed with antibiotics. Ten out of 70 (14%) patients underwent locking bolt removal due to it backing out or being prominent and causing wound healing issues. Two out of 70 (3%) patients went on to have below knee amputations. Both were due to ongoing wound problems following open fractures. The hindfoot nail is an important implant when treating complex ankle and distal tibial fractures in an elderly population. It facilitates early mobilization to avoid deconditioning and other medical complications.
摘要：
患有复杂的踝关节或胫骨远端骨折的老年患者通常脆弱且合并症，需要手术以将距骨包含在胫骨下方，以保护软组织包膜并允许早期不受限制的负重。我们对在我们机构接受踝关节或胫骨远端骨折后足钉固定的65岁以上患者进行了回顾性观察性回顾。收集的数据包括：持续伤害，开放性或闭合性损伤,ASA等级,手术时的年龄，逗留时间,术后死亡率,并发症和进一步治疗。主要结果是再次手术。次要结果是感染和1年死亡率。进行了70个后足钉手术。70名患者中有63名是女性。手术后1年内死亡的人的平均年龄为84岁。70人中有45人受伤。70例患者中有11例在手术1年后死亡（手术后1-358天）。70名患者中有5名（7％）发生了感染。其中五分之四的伤害是开放的。由于感染，五分之三的人切除了指甲。5人中有2人用抗生素抑制了感染。70名患者中有10名（14％）因其退出或突出并导致伤口愈合问题而接受了锁定螺栓移除。70名患者中有2名（3％）继续进行膝盖以下截肢。两者都是由于开放性骨折后持续的伤口问题。后足钉是治疗老年人群复杂踝关节和胫骨远端骨折的重要植入物。它有助于早期动员，以避免失调和其他医疗并发症。
