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Abstract：
OBJECTIVE: To evaluate the clinical outcomes of the use of tibiotalocalcaneal nail for the treatment of complex distal tibia and ankle fractures in elderly people, in a major trauma centre.
METHODS: Elderly patients (age > 65) with distal tibia or ankle fractures that underwent stabilization with a tibiotalocalcaneal nail were eligible to participate. Exclusion criteria were patients that died or were lost to follow-up and cases in which the nail was used in a chronic setting, such as malunion and non-union. Main parameters evaluated were fracture union, complications and functional outcomes. The functional outcome was assessed using the Olerud-Molander Ankle Score (OMAS). The minimum follow-up was 12 months.
RESULTS: Thirty-two consecutive patients (12 males) with a mean age of 80.2 years (range 66-98) met the inclusion criteria and formed the basis of this study. Fracture union was achieved in 93.8% of the cases at a mean time of 3.9 months (range 2-8). Two patients developed surgical site infections and underwent reoperation before union. The overall complication rate was 25.1%, while the respective reintervention rate was 18.8%. In terms of functional outcomes, the mean OMAS score was 45, ranging from 20 to 70.
CONCLUSIONS: Tibiotalocalcaneal nailing can be considered as an acceptable less invasive option with good functional outcomes for the treatment of complex distal tibia and ankle fractures in frail patients with problematic local soft tissues.
METHODS: Elderly patients (age > 65) with distal tibia or ankle fractures that underwent stabilization with a tibiotalocalcaneal nail were eligible to participate. Exclusion criteria were patients that died or were lost to follow-up and cases in which the nail was used in a chronic setting, such as malunion and non-union. Main parameters evaluated were fracture union, complications and functional outcomes. The functional outcome was assessed using the Olerud-Molander Ankle Score (OMAS). The minimum follow-up was 12 months.
RESULTS: Thirty-two consecutive patients (12 males) with a mean age of 80.2 years (range 66-98) met the inclusion criteria and formed the basis of this study. Fracture union was achieved in 93.8% of the cases at a mean time of 3.9 months (range 2-8). Two patients developed surgical site infections and underwent reoperation before union. The overall complication rate was 25.1%, while the respective reintervention rate was 18.8%. In terms of functional outcomes, the mean OMAS score was 45, ranging from 20 to 70.
CONCLUSIONS: Tibiotalocalcaneal nailing can be considered as an acceptable less invasive option with good functional outcomes for the treatment of complex distal tibia and ankle fractures in frail patients with problematic local soft tissues.
摘要：
目的：评价胫骨骨髓内钉治疗老年人复杂胫骨和踝关节远端骨折的临床疗效。在一个主要的创伤中心。
方法：老年患者（年龄>65岁）的胫骨或踝关节远端骨折患者接受胫骨骨关节钉的稳定治疗。排除标准是死亡或失去随访的患者，以及在慢性环境中使用指甲的病例。如马兰和非工会。评价的主要参数为断裂结合，并发症和功能结果。使用Olerud-Molander踝关节评分（OMAS）评估功能结果。最短随访时间为12个月。
结果：32例连续患者（12例男性），平均年龄为80.2岁（范围66-98），符合纳入标准，构成了本研究的基础。在平均3.9个月（范围2-8）的情况下，93.8％的病例实现了骨折愈合。两名患者发生手术部位感染，并在愈合前接受了再次手术。总并发症发生率为25.1%,而再干预率分别为18.8%。就功能结果而言，OMAS平均得分为45分,范围为20~70分.
结论：胫骨大骨骨钉治疗可被认为是一种可接受的侵入性较小的选择，具有良好的功能效果，用于治疗具有局部软组织问题的脆弱患者的复杂胫骨远端和踝关节骨折。
方法：老年患者（年龄>65岁）的胫骨或踝关节远端骨折患者接受胫骨骨关节钉的稳定治疗。排除标准是死亡或失去随访的患者，以及在慢性环境中使用指甲的病例。如马兰和非工会。评价的主要参数为断裂结合，并发症和功能结果。使用Olerud-Molander踝关节评分（OMAS）评估功能结果。最短随访时间为12个月。
结果：32例连续患者（12例男性），平均年龄为80.2岁（范围66-98），符合纳入标准，构成了本研究的基础。在平均3.9个月（范围2-8）的情况下，93.8％的病例实现了骨折愈合。两名患者发生手术部位感染，并在愈合前接受了再次手术。总并发症发生率为25.1%,而再干预率分别为18.8%。就功能结果而言，OMAS平均得分为45分,范围为20~70分.
结论：胫骨大骨骨钉治疗可被认为是一种可接受的侵入性较小的选择，具有良好的功能效果，用于治疗具有局部软组织问题的脆弱患者的复杂胫骨远端和踝关节骨折。
