Open lower extremity fractures in the geriatric population

• Published in: European journal of orthopaedic surgery & traumatology 2023-02, Vol.33 (2), p.401-408
• Main Authors: Friedman, Lisa G. M., Zachos, Terri A., Sanchez, Daniela, Tawari, Akhil, Kempegowda, Harish, Ryan, Scott, Michalowski, Anna, Horwitz, Daniel S.
• Format: Article
• Language: English
• Subjects: Aged; Female; Fibula - injuries; Fibula - surgery; Fracture Fixation, Internal; Fractures, Open - surgery; Geriatrics; Humans; Leg Injuries; Lower Extremity; Male; Medicine; Medicine & Public Health; Open fractures; Original Article; Postoperative period; Retrospective Studies; Surgical Orthopedics; Tibial Fractures - diagnostic imaging; Tibial Fractures - surgery; Traumatic Surgery; Treatment Outcome; Wound healing
• ISSN: 1432-1068; 1633-8065; 1432-1068
• DOI: 10.1007/s00590-022-03209-y

Introduction Open fractures in the elderly are distinct compared to younger populations. The purpose of this study is to follow a series of open fractures of the lower extremity in the geriatric population to better prognosticate outcomes. Methods We performed a retrospective chart review of patients over the age of 65 years old who were treated for an open, lower extremity fracture across two level I trauma medical systems. Patients were included if they had documented wound healing problems in the postoperative period, or 6 months of follow-up, or if they had a definitive radiographic outcome. Sixty-four patients were included of an average age of 76.23, of whom 73.4% were female. Results The fracture types were midshaft femur in 3, distal femur in 9, patella in 2, proximal tibia in 3, proximal fibula in 1, midshaft tibia in 14, distil tibia in 8, ankle in 23, and talar neck/calcaneus in 1. Forty-two fractures were the result of low energy mechanism and 22 fractures were from high energy mechanism. Fourteen fractures were type 1, 32 were type 2, 11 were type 3A, 6 were type 3B, and 1 was type 3C. At final follow-up, 13 wounds were well healed, 39 wounds were healed following a delay of more than 6 weeks to achieve healing, 3 were infected, 3 had been treated with amputation, 2 had chronic ulceration, 2 with active draining, and 2 had draining sinuses. Discussion Open lower extremity fractures are serious injuries with high rates of morbidity. Such risks are even higher in the geriatric population, particularly with regard to wound healing. This study provides important prognostic information in counseling geriatric patient with an open lower extremity fracture, as well as informs treatment in terms of wound surveillance and care in the postoperative period.