Busqueda Fractures Elderly

Acta Orthop Scand. 2004 Feb;75(1):100-5.
Related Articles,
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A prospective cost analysis following operative treatment of

unstable ankle fractures: 30 patients followed for 1 year.
Bhandari M, Sprague S, Ayeni OR, Hanson BP, Moro JK.
Department of Clinical Epidemiology and Biostatistics, McMaster University,
McMaster University Medical Centre, 1200 Main Street West, Room 2C3,
Hamilton, Ontario, L8N 3Z5, Canada. bhandari@sympatico.ca
BACKGROUND: Ankle fractures remain one of the commonest injuries
requiring operation. Quality of life and the overall costs associated with the
treatment of such injuries are rarely reported. We did a pilot study to determine
the cost of treating patients operatively with unstable ankle fractures and to
measure the patients' quality of life (utility scores) over time. PATIENTS AND
METHODS: 30 patients (17 men) were eligible and included in the study. They
were on the average 52 (18-81) years old. All patients had type B Weber
fractures (OTA 44B). RESULTS: The mean utility score from the Health
Utilities Index immediately after surgery was 0.4. At 12 months follow-up, this
score had increased to 0.78. The cost was, on average, USD 2,143 per patient.
INTERPRETATION: Our findings indicate that patients operated on for ankle
fractures had significant gains in health at an acceptable cost. These results
provide data for studies of larger sample size.
PMID: 15022817 [PubMed - indexed for MEDLINE]
2: J Foot Ankle Surg. 2004 Jan-Feb;43(1):3-9.
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Effects of isolated Weber B fibular fractures on the tibiotalar

contact area.
Harris J, Fallat L.
Department of Podiatric Surgery, Oakwood Healthcare System, Dearborn, MI,
USA.
Fractures of the lateral malleolus can occur without rupture of the deltoid
ligament or fracture of the medial malleolus. Controversy exists regarding the
necessity of surgery on supination-external rotation stage II ankle fractures.
Theoretically, as long as the medial structures are intact, the talus cannot
displace enough to cause degenerative arthritis of the ankle joint. The purpose of
this study was to measure changes in contact area between the tibial plafond and
the talar dome with serial displacement of the distal fibula in both a lateral and a
superolateral direction. Twelve cadaver lower extremities were used. Distal
fibular fractures were replicated by creating an osteotomy. Displacement was
accomplished with a customized apparatus that displaced and held the distal
fibula in a malaligned position. Tibiotalar contact area was measured with
pressure sensitive film at the following intervals of fibular displacement: 0 mm,

laterally 2 mm and 4 mm, and then posteriorly and superiorly 2 mm and 4 mm.
A servohydraulic testing apparatus was used to apply the same physiologic load
to all limbs while measuring contact area. Key independent variables included
the direction and amount of displacement of the distal fibula. Mean tibiotalar
contact area decreased from baseline (no displacement) 361.1 mm2 (SD +/49.0) to 162.2 mm2 (SD +/- 81.3) and 82.6 mm2 (SD +/- 30.6) for 2 mm and 4
mm lateral displacement of the distal fibula respectively. With posterior/superior
displacement of 2 mm and 4 mm mean tibiotalar contact decreased to 219.3
mm2 (SD +/- 56.7) and 109.2 mm2 (SD +/- 39.0), respectively. Statistical
significance was found (P <.001) when comparing normal ankle alignment with
displaced fractures at all levels of displacement.
3: Foot Ankle Int. 2003 Nov;24(11):838-44.
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A protocol for treatment of unstable ankle fractures using

transarticular fixation in patients with diabetes mellitus and loss of
protective sensibility.
Jani MM, Ricci WM, Borrelli J Jr, Barrett SE, Johnson JE.
Department of Orthopaedic Surgery, Barnes-Jewish Hospital, The Washington
University School of Medicine, Saint Louis, MO 63110, USA.
BACKGROUND: Surgical treatment of ankle fractures in patients with diabetes
mellitus is associated with a high complication rate. Diabetic patients with
peripheral neuropathy are a particularly difficult group to treat because of their
inability to sense deep infection, repeat trauma, and wound complications. The
purpose of this study was to evaluate a protocol that included transarticular
fixation and prolonged, protected weightbearing in the treatment of unstable
ankle fractures in diabetic patients with peripheral neuropathy and loss of
protective sensibility. METHODS: The authors retrospectively reviewed the
records of 15 patients with diabetes mellitus, unstable ankle fractures (AO
classification 44B), and loss of protective sensibility confirmed via testing with
a 5.07 Semmes-Weinstein monofilament. Retrograde transcalcaneal-talar-tibial
fixation using large Steinmann pins or screws in conjunction with standard
techniques of open reduction and internal fixation was used. The postoperative
treatment protocol included: 1) short leg, total contact casting and
nonweightbearing status for 12 weeks; 2) removal of the intramedullary
implants between 12 and 16 weeks; 3) application of a walker boot or short leg
cast with partial weightbearing for an additional 12 weeks; and 4) transition to a
custom-molded ankle-foot orthosis (AFO) or custom total-contact inserts in
appropriate diabetic footwear. RESULTS: The major complication rate for all
fractures was 25% (4/16) and for closed fractures was 23% (3/13). These are
lower than previously reported rates between 30% (3/10) and 43% (9/21) for
diabetic patients with and without neuropathy. The amputation rate for all
fractures was 13% (2/16) and for closed fractures alone was 8% (1/13). These
are similar to previously reported rates of 10% (2/10) to 20% (2/21). There were
no deaths or Charcot malunions in this series. The combination of transarticular
fixation and prolonged, protected weightbearing provided 13 of 15 patients with
a stable ankle for weightbearing. CONCLUSION: Although these fractures
remain a treatment challenge, this study presents a successful, multidisciplinary
protocol for treatment of unstable ankle fractures in the most challenging group
of diabetic patients - those with loss of protective sensibility.
4: Injury. 2003 Dec;34(12):928-31.
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Soft tissue problems in ankle fractures treated surgically. A

prospective study of 154 consecutive closed ankle fractures.
Hoiness P, Engebretsen L, Stromsoe K.
Oslo Orthopaedic University Clinic, Ullevaal Hospital, N-0407 Oslo, Norway.
p.r.hoiness@medisin.uio.no
We performed a prospective registration of primary soft tissue injuries and
perioperative soft tissue complications the first 3 months after surgery in ankle
fractures treated by open reduction and internal fixation. Open fractures and
polytraumatized patients were excluded. The 154 consecutive patients (90
women) with an average age of 54.5 (S.D. 18.3) years were registered. Primary
soft tissue injuries according to Tscherne's classification were noted in 22
patients (14.2%). Major perioperative soft tissue complications requiring
revision occurred in five patients (3.2%). Minor perioperative soft tissue
complications treated non-operatively occurred in 29 patients (18.8%). A
significantly higher incidence of perioperative soft tissue complications occurred
in alcohol abusers (P=0.043), after high-energy trauma (P=0.043), and after
primary soft tissue injuries (P=0.004). Other possible risk factors such as age,
gender, fracture type, diabetes, arteriosclerosis, coronary heart disease, and
hypothyroidism had no statistically significant influence on the incidence of
perioperative soft tissue complications.
5: Foot Ankle Int. 2003 Oct;24(10):754-64.
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Supramalleolar osteotomy for the treatment of distal tibial angular

deformities and arthritis of the ankle joint.
Stamatis ED, Cooper PS, Myerson MS.
Department of Orthopaedic Surgery, Union Memorial Hospital, Baltimore, MD,

USA.
In a 5-year period (1996-2001), the authors performed supramalleolar
osteotomies for the correction of distal tibial mechanical malalignment of at
least 10 degrees with concomitant pain and with or without radiographic
evidence of arthritic changes. The method was also applied as an alternative to
other common procedures for the treatment of a small group of patients with
degenerative changes of the ankle joint without previous traumatic event and
with minimal or moderately altered alignment. There were 12 patients (13 feet)
with an average follow-up of 33.6 months. All osteotomies healed at an average
time of 14 weeks. The average AOFAS score improved from 53.8 to 87 points,
the average ankle score in the scale described by Takakura et al. improved from
56.7 to 82, and the average pain score improved from 14.6 to 32.3. In the
presence of deformity, the average tibial-ankle surface angles in both the coronal
and the sagittal planes were significantly improved. The radiographic
degenerative changes in the ankle joint showed no evidence of progression. The
choice of technique did not influence the clinical or radiographic outcome or the
healing time of the osteotomy.
6: Clin Orthop. 2003 Sep;(414):37-44.
Related Articles,
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Open ankle fractures in patients with diabetes mellitus.

White CB, Turner NS, Lee GC, Haidukewych GJ.
Mayo Clinic, Rochester, MN 55905, USA.
Complications after surgical treatment of closed ankle fractures in patients with
diabetes previously have been well documented. The purpose of this study was
to evaluate the union rate, infection rate, and soft tissue complication rate in
open ankle fractures in patients with diabetes. Between January 1, 1981 and
December 31, 2000, 14 open ankle fractures in 13 patients with diabetes were
treated. The mean followup was 19 months (range, 6-84 months). All patients
were followed up until union, amputation, or for at least 6 months. Nine of 14
extremities (64%) had wound healing complications. Ultimately, five patients
(six extremities; 42%) had below the knee amputation. Only three of 14
fractures in three patients healed without complications. Open ankle fractures in
patients with diabetes are limb-threatening injuries with high amputation and
infection rates despite contemporary techniques of open reduction and internal
fixation, intravenous antibiotics, and emergent irrigation and debridement.
Publication Types:
Case Reports
7: J Bone Joint Surg Am. 2003 May;85-A(5):820-4.
Related Articles,
Links
Foot and ankle fractures in elderly white women. Incidence and

risk factors.
Hasselman CT, Vogt MT, Stone KL, Cauley JA, Conti SF.
University of Pittsburgh, Pennsylvania, USA.
BACKGROUND: Although foot and ankle fractures are among the most
common nonspinal fractures occurring in older women, little is known about
their epidemiology. This study was designed to determine the incidence of and
risk factors for foot and ankle fractures in a cohort of 9704 elderly, nonblack
women enrolled in the multicenter Study of Osteoporotic Fractures.
METHODS: At their first clinic visit, between 1986 and 1988, the women
provided information regarding lifestyle, subjective health, and function. Bone
mineral density was measured in the proximal and distal parts of the radius and
in the calcaneus. The women were followed for a mean of 10.2 years, during
which time 301 of them had a foot fracture and 291 had an ankle fracture. The
fractures were classified with use of a modification of the Orthopaedic Trauma
Association's guidelines. RESULTS: The incidence of foot fractures was 3.1 per
1000 woman-years, and the incidence of ankle fractures was 3.0 per 1000
woman-years. The most common ankle fracture was an isolated fibular fracture
(prevalence, 57.6%), and the most common foot fracture was a fracture of the
fifth metatarsal (56.9%). Women who sustained an ankle fracture had been
slightly younger at the time of study enrollment than the women who did not
sustain such a fracture (71.0 compared with 71.7 years), they had a higher body
mass index (27.6 compared with 26.5), and they were more likely to have fallen
within the twelve months prior to filling out the original questionnaire (38.1%
compared with 29.7%). The appendicular bone mineral density was not
significantly different between these two groups of subjects. Women who
sustained a foot fracture had a lower bone mineral density in the distal part of
the radius (0.345 g/cm (2) compared with 0.363 g/cm (2) ) and a lower calcaneal
bone mineral density (0.394 g/cm (2) compared with 0.404 g/cm (2) ) than the
women without a foot fracture, they were less likely to be physically active
(62.3% compared with 67.8%), and they were more likely to have had a
previous fracture after the age of fifty (45.5% compared with 36.8%) and to be
using either long or short-acting benzodiazepines. CONCLUSIONS: Overall,
foot fractures appeared to be typical osteoporotic fractures, whereas ankle
fractures occurred in younger women with a relatively high body mass index.
Publication Types:
Multicenter Study
8: Clin Orthop. 2003 Apr;(409):260-7.
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Syndesmotic disruption in low fibular fractures associated with

deltoid ligament injury.
Ebraheim NA, Elgafy H, Padanilam T.
Department of Orthopaedic Surgery, Medical College of Ohio, Dowling Hall
3065 Arlington Avenue, Toledo, OH 43614-5807, USA. nebraheim@mco.edu
Low fibular fractures that were associated with deltoid ligament disruption and
inferior tibiofibular syndesmotic disruption were studied. All of the patients had
a Type B Weber fibular fracture associated with a deltoid ligament injury. It was
difficult to detect the syndesmosis disruption on the initial assessment of the
anteroposterior and mortise radiographs obtained preoperatively because there
was no obvious talar shift on the plain radiograph. Careful evaluation of the
plain radiograph and determination of all the recommended measurements were
necessary to diagnose the syndesmotic disruption. However, the syndesmotic
disruption was easily recognizable on axial computed tomography scans when
comparing the injured and the noninjured sides. Axial computed tomography
scans also showed a shallow incisura fibularis in all patients and in three cases it
revealed anterior fibular subluxation that was not appreciated on the plain
radiographs obtained preoperatively. On the basis of the current study using the
level of the fibular fracture as a guideline for application of the syndesmotic
screw as suggested by some authors may not be accurate. There are several
factors that should be considered including the depth of the incisura fibularis,
posterior malleolus fractures, deltoid ligament injury, and subluxation of the
fibula. The surgeon's impression in the operating room of syndesmosis stability
should be considered as the best guideline in the application of syndesmosis
fixation rather than depending on the level of the fibular fracture.
9: Clin Orthop. 2003 Mar;(408):286-91.
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Distal tibia metaphyseal fractures treated by percutaneous plate

osteosynthesis.
Oh CW, Kyung HS, Park IH, Kim PT, Ihn JC.
Kyungpook National University Hospital, Taegu, Korea. cwoh@knu.ac.kr
Twenty-one patients with fractures of the distal tibial metaphysis, some with
minimal displacement in the ankle, were treated by percutaneous plate
osteosynthesis with a narrow limited contact-dynamic compression plate. Using
the classification by the Arbeitsgemeinschaft fur Osteosynthesefragen and
Orthopaedic Trauma Association, 17 fractures had no articular involvement,
whereas four included intraarticular extension. At final followup (mean, 20
months), all the fractures healed without second procedures and the mean union
time was 15.2 weeks. One patient had malalignment of the limb with 10 degrees
internal rotation, but there were no angular deformities greater than 5 degrees or
any shortening greater than 1 cm. All patients had excellent or satisfactory ankle
function. There were no infections or any soft tissue compromise. Percutaneous
plate osteosynthesis is a safe and worthwhile method of managing such
fractures, which avoids some of the complications associated with conventional
open plating methods.
10: Am J Orthop. 2003 Jan;32(1):46-8.
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Use of a vertical transarticular pin for stabilization of severe ankle

fractures.
Scioscia TN, Ziran BH.
Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh,
Pennsylvania, USA.
Transarticular pin fixation has been used successfully to stabilize severe ankle
fractures. This technique is most commonly used as provisional fixation until
internal fixation is appropriate. In addition, transarticular pin fixation can be a
supplement in cases involving persistent tibiotalar instability after internal
fixation and can provide sole definitive fixation of arthritic and osteoporotic
ankles. In this article, we describe the surgical technique, report results, and
review when transarticular pin fixation may be appropriate. We believe that all
orthopedic surgeons should know this technique--especially those treating cases
of complex orthopedic trauma.
11: Acta Chir Orthop Traumatol Cech. 2002;69(4):243-7.
Related Articles,
[Fracture-dislocations of the ankle joint in adults. Part I:

epidemiologic evaluation of patients during a 1-year period]
[Article in Czech]
Jehlicka D, Bartonicek J, Svatos F, Dobias J.
Links
Ortopedicko-traumatologicka klinika 3. LF UK a FNKV, Praha.

jehlicka@fnkv.cz
PURPOSE OF THE STUDY: The aim of the study is to present a basic
statistical overview of fracture-dislocations of the ankle in adults in a one-year
group of patients. MATERIAL: The analyzed group of patients comprised 232
patients (121 men, 111 women) treated for fracture-dislocations of the ankle at
the authors' department between 1 January and 31 December 1999. In all
patients the physes were closed. The type of fractures was classified after B. G.
Weber. RESULTS: Type A fractures accounted for 23%, Type B fractures for
65% and Type C fractures for 12% of all cases. The average age of the injured
was 49 years (range, 16-89), with men prevailing until 5th decade and women
predominating from 6th decade. In 65% of Type A fractures there occurred only
the fracture of lateral malleolus, in 31% the fracture involved also medial
malleolus and in 4% it affected also the posterior margin of the distal tibia. In
49% of Weber B type of fractures the medial malleolus was fractured, in 20%
the deltoid ligament was ruptured and in 31% there occurred no injury on the
medial aspect. Avulsion of the posterior margin of the distal tibia occurred in
46%. In 71% of Type C fractures the fracture was located in the lower half of
fibula, Maisonneuve type occurred in 29%. Medial malleolus was fractured in
57%, the deltoid ligament was ruptured in 36%, in 7% there was no medial
injury. The posterior margin of the distal tibia was avulsed also in 46%. Fracture
of the posterior margin of the distal tibia occurred in Type A in 4%, in Type B in
46% and in Type C also in 46%. In Types B and C the size of the avulsed
posterior part of the distal tibia covered 1/4 of its articular surface in 75% of
cases, 1/3 in 17% and 1/2 in 8% of cases. DISCUSSION: We have found an
adequate group of patients for comparison only in the Lindsjo work who
evaluated a group of adult patients treated at his department between the
beginning of February 1972 and end of June 1975. Other groups of patients
which we studied and which included some of the parameters that we have
examined are not comparable from the viewpoint of the basic selection of
patients as the selection was made in a different way, namely according to the
manner of treatment, i.e. conservatively or surgically, or according to the
preference of one of the types of the fractures or the period of follow-up. Also,
the so called epidemiological studies concentrated only on one or two factors
(men/women ratio, the cause of injury, the period of the year). In addition, some
works also include fractures in growing individuals. CONCLUSION: Fracturedislocations affect equally men and women. Men prevail until the age of fifty,
women afterwards. The average age of patients was 49 years. Most frequent is
Weber B Type, least frequent Weber C.
12: Bone. 2002 Sep;31(3):430-3.
Related Articles,
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Increasing number and incidence of low-trauma ankle fractures in

elderly people: Finnish statistics during 1970-2000 and projections
for the future.

Kannus P, Palvanen M, Niemi S, Parkkari J, Jarvinen M.
Accident and Trauma Research Center, President Urho Kaleva Kekkonen
Institute for Health Promotion Research, Tampere, Finland. klpeka@uta.fi
To increase knowledge about recent trends in the number and incidence of
various low-trauma injuries among elderly people, we selected, from the
National Hospital Discharge Register, all patients > or =60 years of age who
were admitted to hospitals in Finland (5 million population) for primary
treatment of a first low-trauma ankle fracture during 1970-2000. In each year of
the study, the age-adjusted and age-specific incidence of fracture was expressed
as the number of patients per 100,000 persons. The predicted numbers and
incidence rates of fractures until the year 2030 were calculated using a
regression model. For the study period, the number and incidence of low-trauma
ankle fractures in Finnish persons > or =60 years of age rose substantially: the
total number of fractures increased from 369 in 1970 to 1545 in 2000, a 319%
increase, and the crude incidence increased from 57 to 150, a 163% increase.
The age-adjusted incidence of these fractures also rose in both women (from 66
in 1970 to 174 in 2000, a 164% increase) and men (from 38 in 1970 to 114 in
2000, a 200% increase). The regression model indicates that, if this trend
continues, there will be about three times more low-trauma ankle fractures in
Finland in the year 2030 than there was in 2000. In conclusion, the number of
low-trauma ankle fractures in elderly Finns is rising rapidly at a rate that cannot
be explained simply by demographic changes and, therefore, potentially
effective preventive measures, such as prevention of slippings, trippings, and
falls in elderly people, and use of ankle supports, should be urgently studied.
Copyright 2002 Elsevier Science Inc.
13: Unfallchirurg. 2002 Jul;105(7):643-6.
Related Articles,
Links
[New concept in therapy of distal tibial metaphyseal fractures and

pilon fractures with minor dislocations and severe soft tissue
damage]
[Article in German]
Gehr J, Friedl W.
Klinikum Aschaffenburg, Abteilung Unfall- Hand- und
Wiederherstellungschirurgie, Am Hasenkopf 1, 63739 Aschaffenburg.
jondra@web.de
The treatment of pilon fractures and distal metaphysial tibia fractures demands
very high standards on the osteosynthesis material regarding the soft tissue and
the essential joint reconstruction. The selection of the surgical entrance,

particularly in case of a critical arterial or venous circulation and the possible
irritation of the soft tissue caused by the osteosynthesis material led us to search
for alternative osteosynthesis methods. After the elaboration of a pre-clinical
study and good first results in the treatment of patella, olecranon and ankle joint
fractures by means of the XS-nail the latter is now also employed for pilon
fractures. Within a time period of 8 month 5 fibula fractures coming with pilon
fractures had been treated with the XS-nail. This case report will demonstrate
both the technique of treatment and the flexibility of the new implant.
Publication Types:
Case Reports
14: J Bone Joint Surg Am. 2002 Sep;84-A(9):1528-33.
Related Articles,
Links
Refractures in patients at least forty-five years old. a prospective

analysis of twenty-two thousand and sixty patients.
Robinson CM, Royds M, Abraham A, McQueen MM, Court-Brown CM,
Christie J.
Edinburgh Orthopaedic Trauma Unit, The Royal Infirmary of Edinburgh,
Scotland, United Kingdom. c.mike.robinson@ed.ac.uk
BACKGROUND: Individuals who sustain a low-energy fracture are at increased
risk of sustaining a subsequent low-energy fracture. The incidence of these
refractures may be reduced by secondary preventative measures, although
justifying such interventions and evaluating their impact is difficult without
substantive evidence of the severity of the refracture risk. The aim of this study
was to quantify the risk of sustaining another fracture following a low-energy
fracture compared with the risk in an age and sex-matched reference population.
METHODS: During the twelve-year period between January 1988 and
December 1999, all inpatient and outpatient fracture-treatment events were
prospectively audited in a trauma unit that is the sole source of fracture
treatment for a well-defined local catchment population. During this time,
22,060 patients at least forty-five years of age who had sustained a total of
22,494 low-energy fractures of the hip, wrist, proximal part of the humerus, or
ankle were identified. All refracture events were linked to the index fracture in
the database during the twelve-year period. The incidence of refracture in the
cohort of patients who had sustained a previous fracture was divided by the
"background" incidence of index fractures within the same local population to
obtain the relative risk of refracture. Person-years at-risk methodology was used
to control for the effect of the expected increase in mortality with advancing age.
RESULTS: Within the cohort, 2913 patients (13.2%) subsequently sustained a
total of 3024 refractures during the twelve-year period. Patients with a previous
low-energy fracture had a relative risk of 3.89 of sustaining a subsequent lowenergy fracture. The relative risk was significantly increased for both sexes, but
it was greater for men (relative risk = 5.55) than it was for women (relative risk
= 2.94). The relative risk was 5.23 in the youngest age cohort (patients between
forty-five and forty-nine years of age), and it decreased with increasing age to
1.20 in the oldest cohort (patients at least eighty-five years of age).
CONCLUSIONS: Individuals who sustain a low-energy fracture between the
ages of forty-five and eighty-four years have an increased relative risk of
sustaining another low-energy fracture. This increased risk was greater when the
index fracture occurred earlier in life; the risk decreased with advancing age.
Secondary preventative measures designed to reduce the risk of refracture
following a low-energy fracture are likely to have a greater impact on younger
individuals.
15: Osteoporos Int. 2002;13(4):342-7.
Related Articles,
Links
Site-specific bone measurements in patients with ankle fracture.

Ingle BM, Eastell R.
Division of Clinical Sciences, University of Sheffield, UK.
Ankle fracture is one of the most common fractures in adults, particularly
postmenopausal women. Few studies have examined the bone mineral density
(BMD) and ultrasound properties of bone close to the site of fracture in patients
with ankle fracture. The aim of this study was to evaluate these measurements in
women with ankle fractures compared with controls. We studied 31 healthy
post-menopausal women ages 50-79 years (mean age 63.2+/-3.3 years) from a
population-based group and 31 postmenopausal women ages 52-76 years (mean
age 61.2+/-2.2 years) with an ankle fracture. Distal tibia and fibula BMD were
measured by dual-energy X-ray absorptiometry using the Hologic QDR 1000/W
densitometer. In addition to total distal and tibia BMD, three subregions were
automatically selected: ultradistal, middle and one-quarter regions. Speed of
sound (SOS) and broadband ultrasound attenuation (BUA) of the calcaneus were
measured using the Lunar Achilles+ (LA+) and CUBA Clinical (CC). In
addition to SOS and BUA, LA+ Stiffness Index (SI) was also measured. The
nondominant limb was measured in the population group and the contralateral
limb in the ankle group. Differences between the groups were determined using
t-tests. The ankle fracture group was heavier than the control group by an
average of 10 kg. BMD measurements were therefore adjusted for weight. There
were no significant differences between the ankle fracture and control groups in
lumbar spine BMD, total or regional ankle BMD or calcaneal BUA. However,
calcaneal SOS was decreased in the ankle fracture group when measured on the
LA+ and CC by 50 m/s (-2.0 SD units, p<0.001) and 19 m/s (-0.5 SD units,
p<0.01) respectively. LA+ SI was decreased in the ankle fracture group by 14
units (-1.1 SD units, p<0.001). In conclusion, ankle fracture is not a typical

osteoporotic fracture. However, there may be structural changes in the bone
(unrelated to bone density) which result in increased fragility and susceptibility
to fracture.
16: Osteoporos Int. 2002;13(4):337-41.
Related Articles,
Links
Fractures before menopause: a red flag for physicians.

Hosmer WD, Genant HK, Browner WS.
General Internal Medicine Section, Veterans Affairs Medical Center, San
Francisco & Department of Medicine, University of California, USA.
There is substantial interest in the early identification of women at risk for
osteoporotic fractures, so that preventive measures may be instituted early. We
examined whether women with a history of fractures before menopause were at
an increased risk of fractures after menopause. We obtained information about
any lifetime fractures of the hip, arm, spine, wrist, leg, ankle, foot and finger
from 9086 ambulatory white women ages 65 years and older participating in the
Study of Osteoporotic Fractures. We also measured bone mineral density and
recorded history of falls, maternal fracture history, drug use, diet, functional
status, and other characteristics commonly associated with osteoporotic
fractures. We used proportional hazards models to estimate the effects of
fractures that occurred before menopause on the risk of fractures after
menopause, in particular those that occurred during the 12 years of study followup. The risk of fractures of all types during the study period was greater among
women with a premenopausal fracture of any type compared with women
without a premenopausal fracture (hazard ratio (HR), 1.33; 95% confidence
interval (CI), 1.14-1.56; p<0.001). Adjustment for possible confounders,
including bone mineral density, had only a modest effect (HR, 1.25; 95% CI,
1.03-1.50; p<0.02). An increased risk of fracture among women with a
premenopausal fracture was also seen after stratification by estrogen use,
propensity to fall and maternal fracture history. Premenopausal fractures are
therefore a risk factor for subsequent fractures independent of other risk factors
for osteoporotic fractures, such as bone mineral density. A fracture history,
including fractures before menopause, should be obtained when making
decisions about preventive treatments.
17: J Clin Epidemiol. 2002 May;55(5):452-7.
Related Articles,
The accuracy of self-reported fractures in older people.
Links
Ivers RQ, Cumming RG, Mitchell P, Peduto AJ.

Institute for International Health, University of Sydney, PO Box 576, Newtown
NSW 2042, Sydney, Australia. rivers@iih.usyd.edu.au
Self-report is often used in large-scale studies. Therefore, it is important to
determine the accuracy of self-report. In the Blue Mountains Eye Study, a
population-based study of 3,654 older, community-dwelling Australians,
subjects were asked about fracture history at the 5-year follow-up interview. All
reported non-rib and vertebral fractures were radiologically confirmed. Hospital
radiology records were searched for fracture records of people who reported no
fractures in the 5-year period. Of 2,326 subjects who came to the interview, 272
subjects reported 318 fractures sustained since 1990. Overall, 34.6% of fracture
reports could not be confirmed, mainly due to no record of treatment. Among
self-reported fractures, false positive rates were 10.7% for all fractures and 4.8%
for hip, 2.2% for wrist, 19.4% for ankle, and 6.6% for shoulder fractures.
Sensitivity and specificity of fracture reports was high, with the lowest
sensitivity for shoulder fractures (82.4%). Self-report of major osteoporotic
fractures is reasonably accurate but may be improved by obtaining more details
about treatment.
Publication Types:
Validation Studies
18: Orthopedics. 2002 Apr;25(4):427-30.
Related Articles,
Links
Comment in:
Orthopedics. 2003 Feb;26(2):131; author reply 131.
Treatment of osteoporotic ankle fractures in the elderly: surgical

strategies.
Cole PA, Craft JA.
Department of Orthopedic Surgery, Regions Hospital, St Paul, MN 55101, USA.
The goal of displaced ankle fracture treatment is to restore congruity and
stability to the ankle mortise. However, adequate fixation in patients with
osteoporosis is difficult due to poorly mineralized bone. This article presents
alternative fixation strategies that can helpachieve ankle stability in this patient
population.
19: J Am Geriatr Soc. 2002 Mar;50(3):455-60.
Related Articles,
Links
Rapid resting heart rate: a simple and powerful predictor of

osteoporotic fractures and mortality in older women.
Kado DM, Lui LY, Cummings SR; Study Of Osteoporotic Fractures
Research Group.
Division of Geriatrics, Department of Medicine, University of California-Los
Angeles, 10945 Le Conte Avenue, Suite 2339, Los Angeles, CA 90095, USA.
dkado@mednet.ucla.edu
OBJECTIVES: To determine whether resting heart rate is associated with
several types of osteoporotic fractures, mortality, and cause-specific mortality in
older women. DESIGN: A prospective cohort study. SETTING: Four
communities across the United States. PARTICIPANTS: We prospectively
assessed resting pulse rate in 9,702 women aged 65 and older enrolled in the
Study of Osteoporotic Fractures. MEASUREMENTS: Resting pulse was
measured in the supine position. Hip, humerus, pelvis, rib, ankle, and wrist
fractures were identified by self-report and validated by radiographs. Incident
vertebral fractures were assessed by quantitative morphometry. Cause-specific
mortality was assessed from death certificates and hospital discharge summaries.
RESULTS: Women with resting heart rates of greater than 80 beats per minute
(bpm) (n = 1,140 (12%)) had an adjusted 1.6-fold (95% confidence interval (CI)
= 1.2-2.0) increased risk of either a hip, pelvis, or rib fracture and a 1.9-fold
(95% CI = 1.4-2.5) increased risk of vertebral fracture. A heart rate of 80 bpm or
greater was also associated with 1.4-fold (95% Cl = 1.2-1.5) increased all-cause
mortality and 1.5-fold (95% CI = 1.2-2.1) increased coronary heart disease
mortality. Investigating resting heart rate as a continuous variable, we detected a
general pattern of increasing risks with higher heart rate that could not be
explained by age, weight, poor health, physical activity, hyperthyroidism, or
smoking. CONCLUSIONS: Older women with resting heart rates of 80 bpm or
more have an increased risk of several osteoporotic fractures and of mortality
that is not explained by other risk factors. Heart rate may be a simple tool for
assessing risk of fracture and of death from coronary heart disease in older
women.
20: Arch Orthop Trauma Surg. 2002 Apr;122(3):165-8. Epub

2001 Oct 09.
Conservative functional treatment of ankle fractures.
Related Articles,
Links
Dietrich A, Lill H, Engel T, Schonfelder M, Josten C.

Clinic for General, Thoracic and Oncological Surgery, Leipzig University,
Liebigstr. 20 a, 04103 Leipzig, Germany. dieta@medizin.uni-leipzig.de
Thirty-eight patients (mean age 49 years; range 19-91 years; nine of them over
60 years; 28 women, 10 men) suffering from an isolated Weber B fracture with a
dislocation of less than 1 mm underwent functional therapy using a pneumatic
ankle brace and were included in a prospective study. The clinical outcome was
measured according to the Olerud-Molander ankle score. Functional therapy was
finished in 34 cases successfully. Twenty-one patients were scored after 17
months on average (range 8-27 months) with the Olerud-Molander ankle score.
A very good result was seen in 18 patients, including 12 with 100 points, a
complete remission. The remaining 3 patients showed good results (1 had 90, 2
had 85). However, functional treatment failed in 4 cases due to secondary
dislocation. These patients underwent surgery without further complications.
The control group, 31 operated patients, did not show as good results. Functional
therapy of stable Weber-B ankle fractures appears to be superior to surgery. We
were able to avoid surgery in 90% of our patients and got better results than with
patients undergoing open reduction and internal fixation.
21: Clin Orthop. 2001 Dec;(393):287-93.
Related Articles,
Links
Comment in:
Clin Orthop. 2004 Feb;(419):318; author reply 318-9.
C-reactive protein in patients who had operative fracture

treatment.
Scherer MA, Neumaier M, von Gumppenberg S.
Department for Trauma and Reconstructive Surgery, University Hospital rechts
der Isar der TU-Munchen, Germany.
C-reactive protein as an indicator of infection, may help to detect surgical
complications early and provide a better outcome for patients. To obtain a
baseline for the use of C-reactive protein, the kinetics of C-reactive protein
levels of 330 patients who had operative fracture treatment were studied before
and after surgery. All patients who had an uneventful postoperative course had
similar evolution in their C-reactive protein values: the peak level, which
occurred on the second postoperative day, depended on the region of trauma
(femoral fractures, 15.4 mg/dL versus ankle fractures, 3.5 mg/dL) and reflected
the extent of surgical trauma. Of 47 patients with complicated courses, Creactive protein proved helpful as a marker in risk stratification and as an early
indicator for infection. Of nine patients with a deep wound infection, a high rise
of C-reactive protein was recorded, and seven patients showed a rise in the Creactive protein level before the onset of clinical symptoms. A cut-off level of 14
mg/dL on the fourth day after surgery was recorded for the patients with deep
wound infection.
22: Injury. 2001 Sep;32(7):559-63.
Related Articles,
Links
Internal fixation of ankle fractures in the very elderly.

Srinivasan CM, Moran CG.
Department of Trauma and Orthopaedic Surgery, Queen's Medical Centre,
University Hospital, NG7 2UH, Nottingham, UK.
The management of ankle fracture in the elderly remains controversial. A review
of the early results of open reduction and internal fixation (ORIF) in 74 patients
over the age of 70 years (average 76 years) was undertaken to identify the early
complications, length of stay, return to pre-injury mobility and residential status.
This revealed 1% deep infection, 9% delayed wound healing, 5% malunion, and
3% mortality. In 12% of patients, soft bone and comminution precluded fixation
of one malleolus. The average length of stay for patients who walked with
Zimmer frame (116+/-65 days) before injury was significantly longer than those
who walked independently or with sticks (19+/-15 days; P<0.01). The inability
of the patients to weight-bear early led to lengthy hospital stays and difficult
socio-economic problems. However, the majority (85%) of patients regained
their pre-injury mobility and residential status. We conclude that ORIF of ankle
fractures in the elderly carries a significant risk of wound edge necrosis with
delayed wound healing but the incidence of deep infection is relatively low. Poor
bone quality presents technical difficulties but the majority of patients can
expect good outcome.
23: Foot Ankle Int. 2001 May;22(5):399-402.
Related Articles,
Links
Results of operative fixation of unstable ankle fractures in geriatric

patients.
Pagliaro AJ, Michelson JD, Mizel MS.
University of Vermont, McClure Muscular Skeletal Research Center, Burlington
05405, USA.
It is widely accepted that operative fixation of unstable ankle fractures yields
predictably good outcomes in the general population. The current literature,

however reports less acceptable results in the geriatric population age 65 years
and older. The current study analyzes the outcome of the surgical treatment of
unstable ankle fractures in patients at least 65 years old. Twenty three patient
over 65 years old were surgically treated after sustaining 21 (91%) closed and 2
(9%) open grade II unstable ankle fractures. Fractures were classified according
to the Danis-Weber and Lauge-Hansen schemes. Fracture type was
predominantly Weber B (21/23, 91%), or supination external rotation stage IV
(21/23, 91%). Fracture union rate was 100%. There were three significant
complications including a lateral wound dehiscence with delayed fibular union
in an open fracture dislocation, and two below knee amputations, neither of
which was directly related to the fracture treatment. There were three minor
complications; one superficial wound infection and two cases of prolonged
incision drainage, all of which resolved without further surgical intervention.
Complications were associated with open fractures and preexisting systemic
disease. These results indicate that open reduction and internal fixation of
unstable ankle fractures in geriatric patients is an efficacious treatment regime
that with results that are comparable to the general population.
24: J Bone Joint Surg Br. 2001 May;83(4):525-9.
Related Articles,
Links
Comment in:
J Bone Joint Surg Br. 2001 Sep;83(7):1084-5.
J Bone Joint Surg Br. 2001 Sep;83(7):1085-6.
J Bone Joint Surg Br. 2001 Sep;83(7):1086.
Conservative versus operative treatment for displaced ankle

fractures in patients over 55 years of age. A prospective,
randomised study.
Makwana NK, Bhowal B, Harper WM, Hui AW.
Leicester Royal Infirmary, England.
Forty-seven patients over the age of 55 years with a displaced fracture of the
ankle were entered into a prospective, randomised study in order to compare
open reduction and internal fixation with closed treatment in a plaster cast; 36
were reviewed after a mean of 27 months. The outcome was assessed clinically,
radiologically and functionally using the Olerud score. The results showed that
anatomical reduction was significantly less reliable (p = 0.03) and loss of
reduction significantly more common (p = 0.001) in the group with closed
treatment. Those managed by open reduction and internal fixation had a
significantly higher functional outcome score (p = 0.03) and a significantly
better range of movement of the ankle (p = 0.044) at review.
Publication Types:
Clinical Trial
Randomized Controlled Trial
25: Osteoporos Int. 2001;12(2):97-103.
Related Articles,
Links
Risk factors for ankle fracture.

Greenfield DM, Eastell R.
Bone Metabolism Group, University of Sheffield, Northern General Hospital,
UK.
Ankle fractures are frequently observed in postmenopausal women although the
pattern of incidence and risk factor profile suggest that ankle fracture may not be
a typical osteoporotic fracture. The aims of this study were to determine the
prevalence of osteopenia and vertebral fracture and to evaluate the diagnostic
accuracy of dual-energy X-ray absorptiometry (DXA), anthropometry, lifestyle
and reproductive factors in women who have sustained an ankle fracture. We
studied 103 women aged 50-80 years (mean 63.2, 7.9 SD) with ankle fracture.
These were compared with 375 women aged 50-86 years (mean 64.5, 9.1 SD)
from a population-based cohort. Bone mineral density (BMD) at the lumbar
spine (LS) and contralateral proximal femur (including femoral neck (FN),
Ward's triangle (WT) and trochanteric region (TR)) was measured by DXA.
Quantitative ultrasound (QUS) of the calcaneus and proximal digits was
measured using three different devices. Radiographs of the thoracolumbar spine
were taken (anteroposterior and lateral views). There were no significant
differences in the prevalence of osteoporosis (T<-2.5 level) at the LS, FN and
WT sites. The population-based cohort had lower TR BMD than the ankle
fracture cohort. Age-and weight-adjusted Z-scores of FN BMD were
significantly lower in the ankle fracture group. Age- and weight-adjusted Zscores of QUS gave contradictory results. There were no differences in the
receiver operating characteristics of DXA compared with QUS. Twenty-seven
women (7%) of the population-based cohort and 10 women (10%) of the ankle
fracture cohort were found to have prevalent vertebral fractures; these were not
significantly different.
26: J Orthop Sci. 2000;5(6):552-4.
Related Articles,
Successful immediate weight-bearing of internal fixated ankle
Links
fractures in a general population.

Harager K, Hviid K, Jensen CM, Schantz K.
Department of Orthopaedics, University Hospital, Gentofte, 65 Niels
Andersensvej, Hellerup 2900, Denmark.
Several studies on operated ankle fractures have shown that immediate weightbearing is recommendable. Consequently, we changed our postoperative
standard regimen, from 3 weeks of non-weight-bearing followed by 3 weeks of
weight-bearing, to full immediate weight-bearing in all 6 weeks. A below-knee
walking cast was applied immediately after surgery. Between December 1995
and September 1996, we studied 62 patients (median age, 55 years; range 21-92
years; M/F, 24/38), with ankle fractures who attended our emergency department
and were subsequently admitted for open reduction and internal fixation. We
excluded patients with distal tibia fracture and patients under 18 years of age.
Overall, our elderly population did not have complication rates higher than those
reported in similar studies on younger patients. In 1 patient, we observed
radiographic widening of the ankle joint, of about 3 mm, 6 weeks
postoperatively. No patients required reoperation. Our study indicates that full
immediate weight-bearing after open reduction and internal fixation is
recommendable, even in an elderly population.
27: J Bone Joint Surg Br. 2000 Mar;82(2):246-9.
Related Articles,
Links
Functional outcome of surgery for fractures of the ankle. A

prospective, randomised comparison of management in a cast or a
functional brace.
Egol KA, Dolan R, Koval KJ.
Fracture Service, Hospital for Joint Diseases, New York, NY, USA.
We randomised prospectively 60 consecutive patients who were undergoing
internal fixation of similar fractures of the ankle into two groups, one of which
was treated by immobilisation in a below-knee cast and the other by a functional
brace with early movement. All were instructed to avoid weight-bearing on the
affected side. They were seen at 6, 12, 26 and 52 weeks. The functional rating
scale of Mazur et al was used to evaluate the patients at each follow-up and we
recorded the time of return to work. After one year the patients completed the
SF-36 questionnaire. By then 55 patients remained in the study, 28 (mean age
45.5 years) in group 1 and 27 (mean age 39.5 years) in group 2. Those in group
2 had higher functional scores at each follow-up but only at six weeks was this
difference significant (p = 0.02). They also had higher mean SF-36 scores, but
this difference was significant only for two of the eight aspects investigated. For
patients gainfully employed, not on workers' compensation, the mean time from
surgery to return to work was 53.3 days for group 2 and 106.5 days for group 1;
this difference was significant (p = 0.01). No patient developed a problem with
the wound or had loss of fixation. Our findings support the use of a functional
brace and early movement after surgery for fractures of the ankle.
Publication Types:
Clinical Trial
28: Arch Orthop Trauma Surg. 2000;120(9):511-3.
Related Articles,
Links
The epidemic of ankle fractures in the elderly--is surgical treatment

warranted?
Salai M, Dudkiewicz I, Novikov I, Amit Y, Chechick A.
The Orthopedic WingDivision, The Chaim Sheba Medical Center, Tel
Hashomer, Israel. salai_dr@netvision.net.il
Ankle fractures in the elderly are extremely common (up to 184 fractures per
100,000 persons per year, and of these approximately 20%-30% occur in the
elderly). The medical literature contains no research that has investigated ankle
fractures in the elderly. A prospective, randomised study was conducted of 84
patients with displaced ankle fractures, who were over the age of 65 years and
were assigned to operative or conservative treatment after closed reduction. The
results of treatment assessed according to the American Orthopedic Foot and
Ankle Society (AOFAS) Score showed a mean of 91.37 +/- 8.96 in the nonoperated group compared with 75.2 +/- 14.38 (P = 0.001) in the operated group.
The costs of treatment were accordingly higher. These results call for
consideration of a non-operative approach to the treatment of well-reduced ankle
fractures in the elderly. Increased efforts should be invested in the prevention of
these common fractures.
Publication Types:
Clinical Trial
29: Ann Intern Med. 2000 Jul 18;133(2):123-7.

Comment in:
Related Articles,
Links
Ann Intern Med. 2001 May 1;134(9 Pt 1):795-6.
Body size and risk for clinical fractures in older women. Study of
Osteoporotic Fractures Research Group.
Margolis KL, Ensrud KE, Schreiner PJ, Tabor HK.
Division of Clinical Epidemiology, Hennepin County Medical Center, and
School of Public Health, University of Minnesota, Minneapolis 55415, USA.
BACKGROUND: Small body size predicts hip fractures in older women.
OBJECTIVE: To test the hypothesis that small body size predicts the risk for
other clinical fractures. DESIGN: Prospective cohort study. SETTING:
Population-based listings in four areas of the United States. PATIENTS: 8059
ambulatory nonblack women 65 years of age or older. MEASUREMENTS:
Weight, weight change since 25 years of age, body mass index, lean body mass
and percent body fat, and nonspine fractures during 6.4 years of follow-up.
RESULTS: Compared with women in the highest quartile of weight, women in
the lowest quartile had relative risks of 2.0 (95% CI, 1.5 to 2.8) for hip fractures,
2.3 (CI, 1.1 to 4.7) for pelvis fractures, and 2.4 (CI, 1.5 to 3.9) for rib fractures.
Adjustment for total-hip bone mineral density eliminated the elevated risk.
Results were similar for other body size measures. Smaller body size was not a
risk factor for humerus, elbow, wrist ankle, or foot fractures. CONCLUSIONS:
Total body weight is useful in the prediction of hip, pelvis, and rib fractures
when bone mineral density has not been measured.
30: Foot Ankle Int. 2000 Apr;21(4):311-9.
Related Articles,
Links
Closed ankle fractures in the diabetic patient.

Flynn JM, Rodriguez-del Rio F, Piza PA.
Orthopaedic Section of the University of Puerto Rico School of Medicine and
the San Juan Veterans Administration Hospital, 00936-5067, USA.
jmflynn@coqui.net
Systemic and local manifestations of diabetes mellitus may complicate the
treatment of ankle fractures in the diabetic population. We studied 98 patients
(73 non-diabetics and 25 diabetics) who were treated for closed ankle fractures
by either surgical or non-surgical methods. We found that overall, the risk of
infection in the diabetic population (32%) was 4 times higher than in the nondiabetic population (8%). The infection rate in the diabetic group treated
surgically more than doubled that in the non-diabetic group. Four out of six
diabetic patients treated with cast became infected compared to no infections in
the five non-diabetics treated with a cast. Even though the diabetic foot and
ankle are well studied, the medical literature is not conclusive regarding the
management of ankle fractures in the diabetic patient. Diabetic patients treated
conservatively had a tendency to become infected over those treated surgically.
Peripherovascular disease, peripheral neuropathy and swelling and/or
ecchymosis increased the risk of infection in the diabetic population. Diabetic
patients with poor compliance had a tendency to become infected more than
those who were compliant. We concluded that the diabetic patient who is poorly
compliant with evidence of neuropathic disease, peripherovascular disease and
severe swelling and ecchymosis presents the most difficult group to manage.
Although these patients are poor surgical candidates, they are also the most
difficult to manage and also most prone to infection and complications if treated
conservatively. When faced with this difficult scenario a multidisciplinary team
approach would probably yield the best possible results by early identification
and intervention in these patients.
31: Unfallchirurg. 2000 Mar;103(3):215-9.
Related Articles,
Links
[Cast immobilization versus vacuum stabilizing system. Early

functional results after osteosynthesis of ankle joint fractures]
[Article in German]
Stockle U, Konig B, Tempka A, Sudkamp NP.
Humboldt Universitat zu Berlin. ulrich.stoeckle@charite.de
In a prospective randomized trial the early functional results after
immobilisation in a cast were compared to those after using a vacuum stabilizing
system. The vacuum stabilizing system Vacoped offers equivalent stability
compared to a plaster cast. In contrast to the cast the Vacoped can be removed
for body care and physical therapy. Additionally the range of motion for dorsal
flexion/extention in the upper ankle joint can be adjusted. From 9/1996 to
7/1997 there were 40 patients included in the study with an operated ankle
fracture as monotrauma. Six weeks postoperatively the patients with cast
treatment showed significantly higher functional deficits for the upper ankle
joint (20%), the lower ankle joint (40%) and muscle atrophy (2.1 cm side
difference) than the group with the vacuum stabilizing system (upper ankle joint
15%, lower ankle joint 25%, 1.4 cm muscle atrophy). Five patients out of the
group with the vacuum system were already at work three weeks
postoperatively. Three months postoperatively the functional results for both
groups were approximating. The vacuum stabilizing system Vacoped offers
better early functional results than conventional cast treatment after
osteosynthesis of ankle fractures. Because of the increased patient comfort and
the early ability for physical therapy the vacuum stabilizing system is preferable
to cast treatment.

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Acta Orthop Scand. 2004 Feb;75(1):100-5.

A prospective cost analysis following operative treatment of

2: J Foot Ankle Surg. 2004 Jan-Feb;43(1):3-9.

Effects of isolated Weber B fibular fractures on the tibiotalar

pressure sensitive film at the following intervals of fibular displacement: 0 mm,

3: Foot Ankle Int. 2003 Nov;24(11):838-44.

A protocol for treatment of unstable ankle fractures using

4: Injury. 2003 Dec;34(12):928-31.

Soft tissue problems in ankle fractures treated surgically. A

5: Foot Ankle Int. 2003 Oct;24(10):754-64.

Supramalleolar osteotomy for the treatment of distal tibial angular

Department of Orthopaedic Surgery, Union Memorial Hospital, Baltimore, MD,

6: Clin Orthop. 2003 Sep;(414):37-44.

Open ankle fractures in patients with diabetes mellitus.

PMID: 12966274 [PubMed - indexed for MEDLINE]

7: J Bone Joint Surg Am. 2003 May;85-A(5):820-4.

Foot and ankle fractures in elderly white women. Incidence and

PMID: 12728031 [PubMed - indexed for MEDLINE]

8: Clin Orthop. 2003 Apr;(409):260-7.

Syndesmotic disruption in low fibular fractures associated with

9: Clin Orthop. 2003 Mar;(408):286-91.

Distal tibia metaphyseal fractures treated by percutaneous plate

10: Am J Orthop. 2003 Jan;32(1):46-8.

Use of a vertical transarticular pin for stabilization of severe ankle

11: Acta Chir Orthop Traumatol Cech. 2002;69(4):243-7.

[Fracture-dislocations of the ankle joint in adults. Part I:

Ortopedicko-traumatologicka klinika 3. LF UK a FNKV, Praha.

12: Bone. 2002 Sep;31(3):430-3.

Increasing number and incidence of low-trauma ankle fractures in

for the future.

13: Unfallchirurg. 2002 Jul;105(7):643-6.

[New concept in therapy of distal tibial metaphyseal fractures and

the essential joint reconstruction. The selection of the surgical entrance,

14: J Bone Joint Surg Am. 2002 Sep;84-A(9):1528-33.

Refractures in patients at least forty-five years old. a prospective

15: Osteoporos Int. 2002;13(4):342-7.

Site-specific bone measurements in patients with ankle fracture.

units (-1.1 SD units, p<0.001). In conclusion, ankle fracture is not a typical

16: Osteoporos Int. 2002;13(4):337-41.

Fractures before menopause: a red flag for physicians.

17: J Clin Epidemiol. 2002 May;55(5):452-7.

The accuracy of self-reported fractures in older people.

Ivers RQ, Cumming RG, Mitchell P, Peduto AJ.

18: Orthopedics. 2002 Apr;25(4):427-30.

Treatment of osteoporotic ankle fractures in the elderly: surgical

19: J Am Geriatr Soc. 2002 Mar;50(3):455-60.

Rapid resting heart rate: a simple and powerful predictor of

20: Arch Orthop Trauma Surg. 2002 Apr;122(3):165-8. Epub

Conservative functional treatment of ankle fractures.

Dietrich A, Lill H, Engel T, Schonfelder M, Josten C.

21: Clin Orthop. 2001 Dec;(393):287-93.

C-reactive protein in patients who had operative fracture

22: Injury. 2001 Sep;32(7):559-63.

Internal fixation of ankle fractures in the very elderly.

23: Foot Ankle Int. 2001 May;22(5):399-402.

Results of operative fixation of unstable ankle fractures in geriatric

predictably good outcomes in the general population. The current literature,

24: J Bone Joint Surg Br. 2001 May;83(4):525-9.

Conservative versus operative treatment for displaced ankle

25: Osteoporos Int. 2001;12(2):97-103.

Risk factors for ankle fracture.

26: J Orthop Sci. 2000;5(6):552-4.

Successful immediate weight-bearing of internal fixated ankle