65세 이상 골다공증 환자에서의 족관절 골절의 임상적 특징
Clinical Characteristics of Ankle Fracture in Osteoporotic Patients Over Sixty-five Years of Age
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Objectives: Fracture of multiple sites can occur by minor trauma because decreased bone quality and bone density in osteoporotic patients. To investigate clinical characteristics of ankle fracture in osteoporotic patients over sixty-five years of age. Materials and Methods: From January 2009 to December 2011, excluding distal tibial shaft and pilon fracture, 40 patients (over 65 years old) who were diagnosed the osteoporosis and observed over 6 months after ankle surgery. We measured age, gender, body mass index (BMI, kg/m2), bone mineral density (BMD, mg/cm3) and T-score through P-QCT. Type of fracture was classified into Danis-Weber and AO classification and whether or not of syndesmotic injury and concomitant disease. Surgery performed under AO principle. We investigated by wound healing, fixation failure and bone union during follow-up. Results: The mean age was 70.3 years at surgery, 21 patients were male, and 19 patients were female. Mean BMI was 24.1 kg/m2 (mean weight 63.4 kg/mean height 162.2 cm), mean BMD was 63.6 mg/cm3, and T-score was -3.77. In all cases occurred by low energy rotational injury. Lateral malleolar fracture was 19 cases (48%), bimalleolar fracture was 10 cases, medial malleolar fracture was 7 cases, and trimalleolar fracture was 4 cases. Danis-Weber type B was 28 cases (70%), AO classification type B1 was 18 cases, type B2 was 5 cases, type B3 was 5 cases. In AO classification type A, medial malleolar fracture was 7 cases, bimalleolar fracture was 3 cases, lateral malleolar fracture was 1 case. Type C segmental fibular fracture was only 1 case (C2). There was no case with syndesmotic injuried, there was only 1 case with ankle subluxation in trimalleolar fracture. In case of concomitant disease were 24 cases. There were no wound infection and fixation failure. We obtained bone union in all case after 6 month. Conclusions: Ankle fracture in osteoporotic patients over sixty-five years of age occurred by minor trauma, in all cases, there were Danis-Weber AO B1 type and there were no syndesmotic injury. Surgery was performed under only AO principles without augmentation method for osteoporosis, and we obtained bone union in all cases without complication like as fixation failure and wound problem.
Abstract
Objectives: Fracture of multiple sites can occur by minor trauma because decreased bone quality and bone density in osteoporotic patients. To investigate clinical characteristics of ankle fracture in osteoporotic patients over sixty-five years of age. Materials and Methods: From January 2009 to December 2011, excluding distal tibial shaft and pilon fracture, 40 patients (over 65 years old) who were diagnosed the osteoporosis and observed over 6 months after ankle surgery. We measured age, gender, body mass index (BMI, kg/m2), bone mineral density (BMD, mg/cm3) and T-score through P-QCT. Type of fracture was classified into Danis-Weber and AO classification and whether or not of syndesmotic injury and concomitant disease. Surgery performed under AO principle. We investigated by wound healing, fixation failure and bone union during follow-up. Results: The mean age was 70.3 years at surgery, 21 patients were male, and 19 patients were female. Mean BMI was 24.1 kg/m2 (mean weight 63.4 kg/mean height 162.2 cm), mean BMD was 63.6 mg/cm3, and T-score was -3.77. In all cases occurred by low energy rotational injury. Lateral malleolar fracture was 19 cases (48%), bimalleolar fracture was 10 cases, medial malleolar fracture was 7 cases, and trimalleolar fracture was 4 cases. Danis-Weber type B was 28 cases (70%), AO classification type B1 was 18 cases, type B2 was 5 cases, type B3 was 5 cases. In AO classification type A, medial malleolar fracture was 7 cases, bimalleolar fracture was 3 cases, lateral malleolar fracture was 1 case. Type C segmental fibular fracture was only 1 case (C2). There was no case with syndesmotic injuried, there was only 1 case with ankle subluxation in trimalleolar fracture. In case of concomitant disease were 24 cases. There were no wound infection and fixation failure. We obtained bone union in all case after 6 month. Conclusions: Ankle fracture in osteoporotic patients over sixty-five years of age occurred by minor trauma, in all cases, there were Danis-Weber AO B1 type and there were no syndesmotic injury. Surgery was performed under only AO principles without augmentation method for osteoporosis, and we obtained bone union in all cases without complication like as fixation failure and wound problem.
참고문헌 (21)
- King CM, "Association between ankle fractures and obesity", J Foot Ankle Surg, 51, pp.543~547 (2012)
- Pritchard JM, "Ankle fractures do not predict osteoporotic fractures in women with or without diabetes", Osteoporos Int, 23, pp.957~962 (2012)
- Hasselman CT, "Foot and ankle fractures in elderly white women. Incidence and risk factors", J Bone Joint Surg Am, 85, pp.820~824 (2003)
- Stein EM, "Abnormal microarchitecture and stiffness in postmenopausal women with ankle fractures", J Clin Endocrinol Metab, 96, pp.2041~2048 (2011)
- Seeley DG, "Predictors of ankle and foot fractures in older women. The study of osteoporotic fractures research group", J Bone Miner Res, 11, pp.1347~1355 (1996)
- Holmberg AH, "Risk factors for fragility fracture in middle age. A prospective populationbased study of 33,000 men and women", Osteoporos Int, 17, pp.1065~1077 (2006)
- Fong W, "The treatment of unstable ankle fractures in patients over eighty years of age", Foot Ankle Int, 28, pp.1256~1259 (2007)
- Panchbhavi VK, "Comparison of augmentation methods for internal fixation of osteoporotic ankle fractures", Foot Ankle Int, 30, pp.696~703 (2009)
- Kettunen J, "Surgical treatment of ankle and foot fractures in the elderly", Osteoporos Int, 16, pp.S103~S106 (2005)
- Ruedi TP, "AO principle of fracture management", pp.559~581 (2000), Thieme
- Johnell O, "Epidemiology of osteoporotic fracture", Osteoporos Int, 16, pp.S3~S7 (2005)
- Greenfield DM, "Risk factors for ankle fracture", Osteoporos Int, 12, pp.97~103 (2001)
- Taylor AJ, "Clinical and demographic factors associated with fractures among older Americans", Osteoporos Int, 22, pp.1263~1274 (2011)
- Gnudi S, "Relationship of body mass index with main limb fragility fractures in postmenopausal women", J Bone Miner Metab, 27, pp.479~484 (2009)
- Valtola A, "Lifestyle and other factors predict ankle fractures in perimenopausal women: a population-based prospective cohort study", Bone, 30, pp.238~242 (2002)
- Kim T, "Fixation of osteoporotic distal fibular fractures: a biomechanical comparison of locking versus conventional plates", J Foot Ankle Surg, 46, pp.2~6 (2007)
- Koval KJ, "A new technique for complex fibular fracture fixation in the elderly: a clinical and biomechanical evaluation", J Orthop Trauma, 11, pp.28~33 (1997)
- Dunn WR, "An augmented fixation method for distal fibular fractures in elderly patients: a biomechanical evaluation", Foot Ankle Int, 25, pp.128~131 (2004)
- Panchbhavi VK, "Combination of hook plate and tibial pro-fibular screw fixation of osteoporotic fractures: a clinical evaluation of operative strategy", Foot Ankle Int, 26, pp.510~515 (2005)
- Ramasamy PR, "The role of a fibular nail in the management of Weber type B ankle fractures in elderly patients with osteoporotic bone - a preliminary report", Injury, 32, pp.477~485 (2001)
- Schaffer JJ, "The antiglide plate for distal fibular fixation. A biomechanical comparison with fixation with a lateral plate", J Bone Joint Surg Am, 69, pp.596~604 (1987)