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The rapidly growing elderly population is living longer, active lifestyles with significant comorbidities. Modern literature challenges the conservative approach to elderly ankle fractures. Our aim is to investigate the outcome of ankle fractures in patients aged over 80 years of age by treatment modality. Methods: We retrospectively reviewed all consecutive displaced ankle fractures requiring admission in patients over 80 years old at our level 1 trauma centre over 5 years. Conservative management was compared with open reduction and internal fixation (ORIF) and external fixation (Ex-Fix) as a mode of definitive treatment. Primary outcomes measures included length of stay, wound complications including infection, thromboembolic disease and mortality. Results: We reviewed 35 fractures with 9 Ex-Fix, 6 ORIF’s and 20 managed conservatively. Surgical intervention resulted in longer lengths of stay compared to conservative management with a median length of stay of 19.5 compared to 51 in the surgical group (p=0.006). ORIF provided good reduction at a cost of wound infections and the need for further procedures. Ex-Fix had the highest risk of mortality and risk of malunion (33%). Conservative management experienced malunion in 25% but avoided the surgical complications. Discussion: Complications were experienced in all groups reflecting the difficult management decisions posed in these patients. A patient-by-patient assessment and discussion is key to assess function and physical demands. For low demand and frail patients conservative therapy is a logical choice. ORIF can be considered in the more active and independent as long as the risks are fully understood.

The management of ankle fractures in octogenarian and nonagenarians. What is the optimum mode of treatment?