Abstracts / Injury Extra 43 (2013) 71–127 97

[2A.23]

Treatment of unstable ankle fractures in the elderly – Shouldwe perform osteosynthesis of osteoporotic bone?

K.S. Wronka ∗, H. Salama, B. Ramesh

Glan Clwyd Hospital, Rhyl, Wales, United Kingdom

Background: Ankle fractures in the elderly with osteoporoticbones are often difficult to manage. There is an argument ofwhether we should treat such fractures conservatively, surgically,or even plan primary arthrodesis. Furthermore, there is risk of dif-ficult or failed fixation.

Material and methods: The study was a retrospective evaluationof the management and follow up of 126 patients presented withdisplaced ankle fracture between 2001 and 2007. All patients wereabove 60 years at the time of injury.

Results: Nearly 75% of our patients underwent open reductionand internal fixation (ORIF). The remaining had closed manipu-lation under anaesthesia (MUA) performed. Some patients hadmultiple co-morbidities including diabetes (14% of patients). Theresults of fixation were satisfactory. Early complications includedsuperficial wound infection (13% of patients), one chest infec-tion. There was no difference in diabetic patients. Metal workfailure occurred in one case only. Satisfactory union of fracturewas achieved in all patients. Only minority of patients developedchronic ankle pain (4%), no patient developed significant defor-mity. Amongst patients who underwent MUA, more than 22% hadchronic ankle pain. Significant ankle deformity was reported in 9%of patients, one patient required amputation of 5th foot ray due topressure sores due to cast and osteomyelitis.

Conclusion: Our results show that accurate reduction and inter-nal fixation of ankle fracture in elderly patients is beneficial and oflower complication rates compared to MUA alone. The osteosyn-thesis failure rate was very low and patient spent less time in plasterand started physiotherapy earlier. Long term outcome was betterin group of patients who had ORIF.

http://dx.doi.org/10.1016/j.injury.2012.07.272

[2A.25]

Ankle injury manipulation with or without X-ray! Is it time tochange the mindset?

G. Hastie ∗, S. Javed, H. Divecha, Y. Khaled, G. Nandhara,M. Hakimi, A. Zubairy

Royal Blackburn Hospital, Blackburn, United Kingdom

Purpose of the study: Many deformed ‘looking’ ankles are manip-ulated ‘blindly’ in the emergency department before x-ray in theabsence of neurovascular compromise or critical skin withoutthought to the other possible injuries presenting with swelling anddeformity of the ankle region such as a ligamentous, talar, subta-lar or calcaneal injury. A balance needs to be struck with soundclinical judgement between making the correct diagnosis and pre-venting any further neurovascular compromise or pressure on theoverlying skin.

We have prospectively reviewed the management of 180patients admitted to Royal Blackburn Hospital. We examined theA&E notes specifically assessing if manipulation was performed;if so was it prior to X-ray and the documented reasons for thismanipulation.

Results: The results show 80 ankle fractures were manipulatedand 30 of these were prior to X-ray. 1 of these manipulations wasdue to vascular compromise, 1 for nerve damage, 3 for critical skinand 25 for undocumented reasons. Outcomes (re-manipulation,

delay to surgery and ORIF) were assessed according to whetherthe initial manipulation was performed before or after an X-ray,using Pearson’s Chi-square test for proportions. Remanipulationwas found to be significant (p = 0.03). 44% of fractures manipulatedbefore X-ray required remanipulation, compared to 18% of thosemanipulated after X-ray. Delay to surgery and need for ORIF werenot statistically different between the two groups.

Conclusions: We conclude that taking ankle injury radiographsprior to any attempt at manipulation, in the absence of NV deficitor critical skin, will constitute best practice as it provides a betterassessment of fracture site and configuration, assists with initialreduction and significantly lowers the risk of re-manipulation andthe associated potential risks associated with sedation withoutdelaying surgery.

http://dx.doi.org/10.1016/j.injury.2012.07.273

[2A.26]

The outcome of percutaneous repair of acute achilles tendonrupture followed by early weight bearing and an acceleratedrehabilitation programme

L. Al-Mouazzen ∗, K. Rajakulendran, N. Ahad

Barking, Havering & Redbridge University Hospitals, United Kingdom

Introduction: The management of acute Achilles Tendon (AT)rupture still divides orthopaedic opinion. The advent of minimallyinvasive endoscopic or percutaneous techniques is thought to allowfaster rehabilitation. We report the outcome of patients with acuteAT ruptures that have undergone percutaneous repair followedby an accelerated rehabilitation programme with early weight-bearing.

Methods: A single centre, prospective cohort study was under-taken. Twenty patients (13 men, 7 women; mean age: 40.11 years)with an acute AT rupture were enrolled and followed-up for a min-imum of 6 months. All operations were performed under localanaesthesia, using a modified percutaneous technique, within 2weeks of injury.

Following surgery, patients were immobilized in an equines castfor only 2 weeks. They were then allowed to weight bear througha DJO walker boot with 3 heel wedges, which were removedsequentially over a 6-week period. A standardized physiotherapyprogramme was started 6 weeks post-operatively and continueduntil 6 months.

The primary outcome measure was the AT re-rupture rate. Sec-ondary outcome measures were the Achilles tendon Total RuptureScore (ATRS) at 3 and 6 months, the incidence of sural nerve injuryand patient satisfaction.

Results: There were no (0%) re-ruptures in the study group. Themean 3- and 6-month ATRS was 57.15 and 85.07 respectively. Thisimprovement was statistically significant (p < 0.001). There wereno cases of sural nerve injury. One superficial wound infection wasidentified and treated with oral antibiotics. All patients were able tofully weight bear on the operated leg by the eighth post-operativeweek, without the walker boot. At the 6 month follow-up, theaverage satisfaction rate with the procedure and the rehabilitationprogramme was 85%.

Conclusion: The results of this study demonstrate that minimallyinvasive repair of acute AT ruptures, combined with an acceler-ated rehabilitation programme provides a safe and reproducibletreatment option.

http://dx.doi.org/10.1016/j.injury.2012.07.274