Clinical Characteristics of Ankle Fracture in Osteoporotic Patients Over Sixty-five Years of Age

Chae, Soo Uk; Kim, Yeung Jin; Choi, Deok Hwa; Kim, Byung Soo

Abstract

OBJECTIVES
Fracture of multiple sites can occur by minor trauma because decreased bone quality and bone density in osteoporotic patients. To investigate clinical characteristics of ankle fracture in osteoporotic patients over sixty-five years of age.
MATERIALS AND METHODS
From January 2009 to December 2011, excluding distal tibial shaft and pilon fracture, 40 patients (over 65 years old) who were diagnosed the osteoporosis and observed over 6 months after ankle surgery. We measured age, gender, body mass index (BMI, kg/m2), bone mineral density (BMD, mg/cm3) and T-score through P-QCT. Type of fracture was classified into Danis-Weber and AO classification and whether or not of syndesmotic injury and concomitant disease. Surgery performed under AO principle. We investigated by wound healing, fixation failure and bone union during follow-up.
RESULTS
The mean age was 70.3 years at surgery, 21 patients were male, and 19 patients were female. Mean BMI was 24.1 kg/m2 (mean weight 63.4 kg/mean height 162.2 cm), mean BMD was 63.6 mg/cm3, and T-score was -3.77. In all cases occurred by low energy rotational injury. Lateral malleolar fracture was 19 cases (48%), bimalleolar fracture was 10 cases, medial malleolar fracture was 7 cases, and trimalleolar fracture was 4 cases. Danis-Weber type B was 28 cases (70%), AO classification type B1 was 18 cases, type B2 was 5 cases, type B3 was 5 cases. In AO classification type A, medial malleolar fracture was 7 cases, bimalleolar fracture was 3 cases, lateral malleolar fracture was 1 case. Type C segmental fibular fracture was only 1 case (C2). There was no case with syndesmotic injuried, there was only 1 case with ankle subluxation in trimalleolar fracture. In case of concomitant disease were 24 cases. There were no wound infection and fixation failure. We obtained bone union in all case after 6 month.
CONCLUSIONS
Ankle fracture in osteoporotic patients over sixty-five years of age occurred by minor trauma, in all cases, there were Danis-Weber AO B1 type and there were no syndesmotic injury. Surgery was performed under only AO principles without augmentation method for osteoporosis, and we obtained bone union in all cases without complication like as fixation failure and wound problem.