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Open tibia/fibula in the elderly: A retrospective cohort study

The incidence of open tibia/fibula fractures in the elderly is increasing, but current national guidelines focus on the aggressive treatment of high-energy injuries in younger patients. There is conflicting evidence regarding whether older age affects treatment provision and outcomes in open fractur...

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Autores principales: Lee, Alice, Geoghegan, Luke, Nolan, Grant, Cooper, Kerri, Super, Jonathan, Pearse, Michael, Naique, Satyajit, Hettiaratchy, Shehan, Jain, Abhilash
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8585579/
https://www.ncbi.nlm.nih.gov/pubmed/34805472
http://dx.doi.org/10.1016/j.jpra.2021.09.003
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author Lee, Alice
Geoghegan, Luke
Nolan, Grant
Cooper, Kerri
Super, Jonathan
Pearse, Michael
Naique, Satyajit
Hettiaratchy, Shehan
Jain, Abhilash
author_facet Lee, Alice
Geoghegan, Luke
Nolan, Grant
Cooper, Kerri
Super, Jonathan
Pearse, Michael
Naique, Satyajit
Hettiaratchy, Shehan
Jain, Abhilash
author_sort Lee, Alice
collection PubMed
description The incidence of open tibia/fibula fractures in the elderly is increasing, but current national guidelines focus on the aggressive treatment of high-energy injuries in younger patients. There is conflicting evidence regarding whether older age affects treatment provision and outcomes in open fractures. The aim of this study was to determine if elderly patients are sustaining a different injury to younger patients and how their treatment and outcomes differ. This may have implications for future guidelines and verify their application in the elderly. In this retrospective single centre cohort study (December 2015–July 2018), we compared the injury characteristics, operative management and outcomes of elderly (≥65 years) and younger (18–65 years) patients with open tibia/fibula fractures. An extended cohort examined free flap reconstruction. In total, 157 patients were included. High-energy injuries were commoner in younger patients (88% vs 37%; p<0.001). Most were Gustilo-Anderson IIIb in both age groups. Elderly patients waited longer until debridement (21:19 vs 19:00 h) and had longer inpatient stays (23 vs 15 days). There was no difference in time to antibiotics, operative approach or post-operative complications. Despite the low-energy nature of elderly patients’ injuries, the severity of soft tissue insult was equivalent to younger patients with high-energy injuries. Our data suggest that age and co-morbidities should not prohibit lower limb reconstruction. The current application of generic guidelines appears suitable in the elderly, particularly in the acute management. We suggest current management pathways and targets be reviewed to reflect the greater need for peri-operative optimisation and rehabilitation in elderly patients.
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spelling pubmed-85855792021-11-18 Open tibia/fibula in the elderly: A retrospective cohort study Lee, Alice Geoghegan, Luke Nolan, Grant Cooper, Kerri Super, Jonathan Pearse, Michael Naique, Satyajit Hettiaratchy, Shehan Jain, Abhilash JPRAS Open Original Article The incidence of open tibia/fibula fractures in the elderly is increasing, but current national guidelines focus on the aggressive treatment of high-energy injuries in younger patients. There is conflicting evidence regarding whether older age affects treatment provision and outcomes in open fractures. The aim of this study was to determine if elderly patients are sustaining a different injury to younger patients and how their treatment and outcomes differ. This may have implications for future guidelines and verify their application in the elderly. In this retrospective single centre cohort study (December 2015–July 2018), we compared the injury characteristics, operative management and outcomes of elderly (≥65 years) and younger (18–65 years) patients with open tibia/fibula fractures. An extended cohort examined free flap reconstruction. In total, 157 patients were included. High-energy injuries were commoner in younger patients (88% vs 37%; p<0.001). Most were Gustilo-Anderson IIIb in both age groups. Elderly patients waited longer until debridement (21:19 vs 19:00 h) and had longer inpatient stays (23 vs 15 days). There was no difference in time to antibiotics, operative approach or post-operative complications. Despite the low-energy nature of elderly patients’ injuries, the severity of soft tissue insult was equivalent to younger patients with high-energy injuries. Our data suggest that age and co-morbidities should not prohibit lower limb reconstruction. The current application of generic guidelines appears suitable in the elderly, particularly in the acute management. We suggest current management pathways and targets be reviewed to reflect the greater need for peri-operative optimisation and rehabilitation in elderly patients. Elsevier 2021-10-01 /pmc/articles/PMC8585579/ /pubmed/34805472 http://dx.doi.org/10.1016/j.jpra.2021.09.003 Text en © 2021 The Authors https://creativecommons.org/licenses/by/4.0/This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Original Article
Lee, Alice
Geoghegan, Luke
Nolan, Grant
Cooper, Kerri
Super, Jonathan
Pearse, Michael
Naique, Satyajit
Hettiaratchy, Shehan
Jain, Abhilash
Open tibia/fibula in the elderly: A retrospective cohort study
title Open tibia/fibula in the elderly: A retrospective cohort study
title_full Open tibia/fibula in the elderly: A retrospective cohort study
title_fullStr Open tibia/fibula in the elderly: A retrospective cohort study
title_full_unstemmed Open tibia/fibula in the elderly: A retrospective cohort study
title_short Open tibia/fibula in the elderly: A retrospective cohort study
title_sort open tibia/fibula in the elderly: a retrospective cohort study
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8585579/
https://www.ncbi.nlm.nih.gov/pubmed/34805472
http://dx.doi.org/10.1016/j.jpra.2021.09.003
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