![]() 2 These patients will need a completely different treatment regime. 17 In particular, in patients with neurogenic osteoarthropathy who are non-diabetic and do not have a hereditary disorder, this condition (‘charcoid’) may be overlooked and standard treatment may lead to catastrophic results. 16Ĭare has to be taken to identify patients with diabetic, hereditary or idiopathic Charcot neuro-osteoarthropathy (CN) at the ankle. 15 Obesity has been identified as an independent risk factor for complications and poorer outcomes in both diabetics and non-diabetics. 11 In addition, more than 40% of diabetic patients also present with peripheral arterial disease. 11, 14 The presence of neuropathy increases the chance of a complication by a factor of 4 in diabetics. The risk of complications and the chances of diabetic comorbidities increase dramatically with poor control of the blood glucose level as reflected by a high HbA 1C value. 10 As a result of these changes in bone metabolism, patients with manifest diabetes have a higher chance of sustaining a more severe ankle fracture along with increased mortality rates. 11 The combination of these pathological conditions results in a significant delay in bone healing in diabetic patients, with reported union times of 163% to 187% when compared with non-diabetic patients. 12 Chronic hyperglycaemia negatively affects the function of immunocompetent cells like fibroblasts and leukocytes leading to significantly increased rates of infection and other complications as compared to non-diabetics. 10- 11 In type I diabetes the missing anabolic effect of insulin and amylin in early stages, and vascular changes in later stages lead to a manifest osteoporosis with increased fracture risk. Clinical and experimental studies have demonstrated a diminished healing capacity of both bone and soft tissues including ligaments in patients with diabetes. This article will discuss current treatment approaches to ankle fractures in elderly patients with specific reference to frequent and relevant comorbidities such as diabetes and osteoporosis.ĭiabetes affects wound and fracture healing on multiple levels. 9 If relevant comorbidities are present, the treatment regimen has to be adapted accordingly. Therefore, in the absence of severe systemic comorbidities, the principal indications for surgery should not differ from those in younger patients. 5- 7 Numerous comparative studies 5, 6, 8 including one prospective-randomised study in patients above 55 years of age 8 found significantly better results after open reduction and internal fixation than after non-operative treatment for displaced malleolar fractures in the elderly. ![]() Cast immobilisation for highly unstable ankle fractures (especially the inherently unstable pronation-abduction fractures that are frequently seen in the elderly) leads to malunion or nonunion rates between 48% and 73%. An increasing number of elderly people retain an active lifestyle with high functional demands. 4ĭespite the inherent higher risks in elderly patients, a therapeutic nihilism is unwarranted. 3 Mobilisation of the patients after surgery will be complicated by sarcopaenia, decreased strength, co-ordination and compliance. 2 The soft tissue envelope may be compromised through chronic vascular disease, prolonged steroid medication, and diminished skin turgor leading to open injuries even in low energy fractures. Poor bone quality in osteoporotic and diabetic patients may lead to more complicated fracture patterns and problems with fixation. 1 The patients are predominately women with considerable comorbidities including cardiovascular diseases, obesity, chronic pulmonary diseases and complicated diabetes. ![]() ![]() Both the incidence and severity of ankle fractures in elderly patients with considerable comorbidity is rising steadily in most European countries. ![]()
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