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Open lower extremity fractures in the geriatric population

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

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.

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Authors and Affiliations

  1. Geisinger Medical Center, 100 N. Academy Ave., Danville, PA, 17822, USA

    Lisa G. M. Friedman

  2. Erie, PA, USA

    Terri A. Zachos

  3. School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia

    Daniela Sanchez

  4. Thunga Hospitals, SRCC Children’s Hospital, Mumbai, India

    Akhil Tawari

  5. Horizon Health, Lewisville, TX, USA

    Harish Kempegowda

  6. Tufts University Medical Center, Boston, MA, USA

    Scott Ryan & Anna Michalowski MD

  7. Geisinger Medical Center, Danville, PA, USA

    Daniel S. Horwitz

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  1. Lisa G. M. Friedman
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  7. Anna Michalowski MD
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  8. Daniel S. Horwitz
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All authors made meaningful contributions to this manuscript.

Corresponding author

Correspondence to Lisa G. M. Friedman.

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Conflict of interest

Lisa G. M. Friedman, Terri A. Zachos, Daniela Sanchez, Akhil Tawari, Harish Kempegowda, Scott Ryan, Anna Michalowski are declare that they have no competing interests. Daniel S. Horwitz has a conflict outside of this submitted work: Design consultant and royalties from Zimmer Biomet, consulting fees from Depuy Synthes.

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This project is IRB approved at both Geisinger and Tufts Medical Center.

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Friedman, L.G.M., Zachos, T.A., Sanchez, D. et al. Open lower extremity fractures in the geriatric population. Eur J Orthop Surg Traumatol 33, 401–408 (2023). https://doi.org/10.1007/s00590-022-03209-y

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  • DOI: https://doi.org/10.1007/s00590-022-03209-y

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