METHODS: A retrospectively single-center cohort was reviewed for all surgically treated ankle fractures in patients aged 75 years and older between 2016 and 2021. The cases were grouped by the surgical technique: ORIF or TTC nailing. Diagnosis and treatment were validated by a review of the radiographs and the patients\' charts. Primary outcomes included complication rates and revision rates. The PROMs questionnaires included the Foot and Ankle-Ability Measure (FAAM-ADL) and the Olerud-Molander Ankle Score (OMAS).
RESULTS: Forty-six cases met the inclusion criteria during the study period. Eighteen in the TTC group and 28 in the ORIF group. The average follow-up was 46.4 months (Median 49.5, SD ± 25.3). The mean age of the TTC group was significantly higher (88.6 versus 81.8, p < 0.001). The mean surgery duration and length of stay were similar. The complication rates were 50.0 % in the ORIF group (28.6 % major) versus 22.2 % in the TTC group (5.6 % major), (p = 0.060). The revision rates were 28.6 % and 11.1 % in the ORIF and TTC groups respectively (p = 0.161). The FAAM-ADL was higher in the ORIF group (62.6 % versus 32.4 %, p = 0.020), as well as the OMAS (60.0 versus 32.8, p = 0.029).
CONCLUSIONS: TTC nailing without joint preparation for unstable fragility fractures of the ankle in the extremely elderly provided a better complication profile compared to traditional ORIF. However, PROMs were inferior.
方法:回顾性单中心队列研究了2016年至2021年间所有75岁及以上的手术治疗踝关节骨折患者。病例按手术技术进行分组:ORIF或TTC钉。诊断和治疗通过对X光片和患者图表的审查得到验证。主要结果包括并发症发生率和翻修率。PROM问卷包括脚和踝关节能力测量(FAAM-ADL)和Olerud-Molander踝关节评分(OMAS)。
结果:研究期间有46例符合纳入标准。TTC组18例,ORIF组28例。平均随访46.4个月(中位数49.5,SD±25.3)。TTC组的平均年龄明显较高(88.6对81.8,p<0.001)。平均手术时间和住院时间相似。ORIF组的并发症发生率为50.0%(主要为28.6%)与TTC组的22.2%(主要为5.6%),(p=0.060)。ORIF组和TTC组的修订率分别为28.6%和11.1%(p=0.161)。ORIF组的FAAM-ADL较高(62.6%对32.4%,p=0.020),以及OMAS(60.0对32.8,p=0.029)。
结论:与传统的ORIF相比,无关节准备的TTC钉治疗高龄踝关节不稳定脆性骨折的并发症情况更好。然而,PROMs较差。