Assessment of Recovery From Geriatric Ankle Fracture Using The Life Space Mobility Assessment (LSA)

Briggs Ahearn MD Claire Mueller BS Stephanie Boden BS Danielle Mignemi ATC Shae Tenenbaum MD Jason Bariteau MD

DisclosuresAll Authors

Geriatric Ankle Fractures

bull Third most common fracture in elderly

bull Ideal treatment paradigm unclear

bull Current outcome measures ineffective in assessing actual mobility ndash Floorceiling effect

ndash True deficits under reported and under appreciated

Introduction

Primary Purpose

1 Assess LSArsquos effectiveness in measuring post-injury mobility following geriatric ankle fractures

Secondary Purposes

1 To identify any differences between operative vs non-operatively managed ankle fractures

Hypothesis

ndash LSA would demonstrate

bull An effective assessment of mobility from geriatric ankle fractures

bull That geriatric ankle fractures are severely limiting

bull Operatively managed ankle fractures to have improved mobility post-op

Example Survey

Methods

bull Prospective observational study

bull Inclusion criteria

ndash Age gt 65

ndash Any type of ankle fracture

bull Treatment modality chosen by attending on patient specific basis

bull LSA administered at initial visit (pre-injury status) 6 weeks 3 months 6 months and 12 months

ndash SF-36 and VAS administered at 6 months and 12 months as current standard of care in this clinic

bull Unadjusted means calculated and compared

Conceptual drawing with average scores to reach each life space level with standard deviations

Results

Overall Non-op

Treatment

ORIF

Treatmen

t

p-value

Gender Male 520

(25)

29 (22) 311

(27)

10000

Femal

e

1520

(75)

79 (78) 811

(73)

Age 748

(62)

(n=20)

742 (73)

(n=9)

754 (54)

(n=11)

06969

Descriptive Statistics

Overall

n Mean (std) Med (Q1 Q3)

LS

Baseline 18 867 (281) 90 (80 104)

6 Week 19 207 (245) 16 (6 24)

3 Months 15 370 (344) 26 (12 80)

6 Months 10 498 (383) 453 (95 82)

12 Months 10 736 (383) 633 (46 120)

Life Space scores over time regardless of treatment

Results Non-operative

Results Operative

Results VAS amp SF-36 Physical

Overall Non-op Treatment ORIF Treatment

n Mean (std) Med (Q1 Q3) n Mean (std) Med (Q1 Q3) N Mean (Std) Med (Q1 Q3)

VAS

6 Months 9 22 (28) 1 (0 4) 4 23 (33) 1 (0 45) 5 22 (26) 1 (02 40)

12 Months 10 19 (21) 15 (0 4) 5 24 (23) 3 (0 4) 5 14 (19) 0 (0 3)

Overall Non-op Treatment ORIF Treatment

n Mean (std) Med (Q1 Q3) n Mean (std) Med (Q1 Q3) N Mean (Std) Med (Q1 Q3)

SF 36 Physical

6 Months 8 554 (153) 556 (471 683) 4 532 (94) 517 (471 593) 4 576 (212) 646 (43 722)

12 Months 9 826 (164) 865 (795 92) 5 601 (259) 905 (795 92) 4 709 (159) 83 (623 933)

Discussion Is LSA effective

LSA results regardless of treatmentndash LSA successful in quantifying changes in

post op mobility

ndash Ankle fractures are significantly limiting in the geriatric population

ndash 6 weeks LS Level 1-2 (bedroomhome) with significant assistance

ndash 6 months LS Level 3-4 (neighborhoodtown) also requiring assistance

ndash 12 months Saw a loss of 1 LS Level from pre-injury status

LSA results based on treatmentndash Operatively treated patientsrsquo scores returned to

baseline while non-operative patients did not

ndash Non-op patients saw a loss of 1 LS level at 12 months

ndash Consistent with results seen in literature regarding improved results with operative management

Caveatsndash Unmatched cohorts Did not control for

confounding variables

ndash Observational conclusion

Conclusion

bull The LSA showed a significant decline in mobility in this population throughout the 12-month recovery

ndash Patients should be counseled accordinglybull Rarely left bedroom or house for first 6 weeks of recovery

bull Left neighborhood or town infrequently and with significant assistance out to 6 months

bull The LSA demonstrated an improvement in mobility in operatively managed ankle fractures albeit in an unmatched cohort

ndash Results of SF-36 Physical mirrored the LSA

ndash Operatively managed patients demonstrated slightly less pain at 12 months

bull This is an effective pilot study for future investigations utilizing the LSA within the Orthopaedic patient population

References

1 Centers for Disease and Control Prevention Home and Recreational Safety [Internet] Atlanta Centers for Disease and Control Prevention c 2014 Older Adult Falls Get the facts [cited 2014 Nov 9] Available from httpwwwcdcgovhomeandrecreationalsafetyfallsadultfallshtml

2 Sporer SM Weinstein JN Koval KJ The geographic incidence and treatment variation of common fractures of elderly patients J Am Acad Orthop Surg 200614(4)246-255

3 Bauer M Bengner U Johnell O Redlund-Johnell I Supinationeversion fractures of the ankle joint changes in incident over 30 years Foot and Ankle 826 ndash 28 1987

4 Begner U Johnell O Reblund-Johnell I Epidemiology of ankle fracture 1950 and 1980 Increasing incidence in elderly women Acta Orthop Scand 57(1)35 ndash 37 1986

5 Guggenbuhl P Meadeb J Chal`es G Osteoporotic fractures of the proximal humerus pelvis and ankle epidemiology and diagnosis Joint Bone Spine 72(5)372 ndash 375 2004

6 httpdxdoiorg101016jjbspin200404002

7 Hasselman CT Vogt MT Stone KL Cauley JA Conti SF Foot and ankle fractures in elderly white women Incidence and risk factors Journal of Bone and Joint Surgery Am 85(5)820 ndash 824 2003

8 Bariteau JT Hsu RH Mor V Lee Y DeGiovanni CW Hayda R Operative versus nonoperative treatment of geriatric ankle fractures A Medicare Part A claims database analysis Foot amp Ankle International 2015 Vol 36(6) 648ndash655

9 Peel C1 Sawyer Baker P Roth DL Brown CJ Brodner EV Allman RM Assessing mobility in older adults the UAB Study of Aging Life-Space Assessment Phys Ther 2005 Oct85(10)1008-119

10 Polku H1 Mikkola TM Portegijs E Rantakokko M Kokko K Kauppinen M Rantanen T Viljanen A Life-space mobility and dimensions of depressive symptoms among community-dwelling older adults Aging Ment Health 2015 Sep19(9)781-9 doi 101080136078632014977768 Epub 2014 Nov 7

11 Stewart CM1 Wheeler TL 2nd Markland AD Straughn JM Jr Richter HE Life-space assessment in urogynecology and gynecological oncology surgery patients a measure of perioperative mobility and function J Am Geriatr Soc 2009 Dec57(12)2263-8 doi 101111j1532-5415200902557x Epub 2009 Oct 26

12 Brown CJ1 Roth DL Allman RM Sawyer P Ritchie CS Roseman JM Trajectories of life-space mobility after hospitalization Ann Intern Med 2009 Mar 17150(6)372-8

13 Kannus P Palvanen M Niemi S Parkkari J Jarvinen M Increasing number and incidence of low-traua ankle fractures in elderly people Finnish statistics during 1970-2000 and projections for the future Bone 200231(3)430-433

14 Koval KJ Lurie J Zhou W et al Ankle fractures in the elderly what you get depends on where you live and who you see J Orthop Trauma 200519(9)635-639

15 Koval KJ Zhou W Sparks MJ Cantu RV Hecht P Lurie J Complications after ankle fracture in elderly patients Foot and Ankle International 200728(12)1249-1255 doi 103113FAI20071249

DisclosuresAll Authors

Geriatric Ankle Fractures

bull Third most common fracture in elderly

bull Ideal treatment paradigm unclear

bull Current outcome measures ineffective in assessing actual mobility ndash Floorceiling effect

ndash True deficits under reported and under appreciated

Introduction

Primary Purpose

1 Assess LSArsquos effectiveness in measuring post-injury mobility following geriatric ankle fractures

Secondary Purposes

1 To identify any differences between operative vs non-operatively managed ankle fractures

Hypothesis

ndash LSA would demonstrate

bull An effective assessment of mobility from geriatric ankle fractures

bull That geriatric ankle fractures are severely limiting

bull Operatively managed ankle fractures to have improved mobility post-op

Example Survey

Methods

bull Prospective observational study

bull Inclusion criteria

ndash Age gt 65

ndash Any type of ankle fracture

bull Treatment modality chosen by attending on patient specific basis

bull LSA administered at initial visit (pre-injury status) 6 weeks 3 months 6 months and 12 months

ndash SF-36 and VAS administered at 6 months and 12 months as current standard of care in this clinic

bull Unadjusted means calculated and compared

Conceptual drawing with average scores to reach each life space level with standard deviations

Results

Overall Non-op

Treatment

ORIF

Treatmen

t

p-value

Gender Male 520

(25)

29 (22) 311

(27)

10000

Femal

e

1520

(75)

79 (78) 811

(73)

Age 748

(62)

(n=20)

742 (73)

(n=9)

754 (54)

(n=11)

06969

Descriptive Statistics

Overall

n Mean (std) Med (Q1 Q3)

LS

Baseline 18 867 (281) 90 (80 104)

6 Week 19 207 (245) 16 (6 24)

3 Months 15 370 (344) 26 (12 80)

6 Months 10 498 (383) 453 (95 82)

12 Months 10 736 (383) 633 (46 120)

Life Space scores over time regardless of treatment

Results Non-operative

Results Operative

Results VAS amp SF-36 Physical

Overall Non-op Treatment ORIF Treatment

n Mean (std) Med (Q1 Q3) n Mean (std) Med (Q1 Q3) N Mean (Std) Med (Q1 Q3)

VAS

6 Months 9 22 (28) 1 (0 4) 4 23 (33) 1 (0 45) 5 22 (26) 1 (02 40)

12 Months 10 19 (21) 15 (0 4) 5 24 (23) 3 (0 4) 5 14 (19) 0 (0 3)

Overall Non-op Treatment ORIF Treatment

n Mean (std) Med (Q1 Q3) n Mean (std) Med (Q1 Q3) N Mean (Std) Med (Q1 Q3)

SF 36 Physical

6 Months 8 554 (153) 556 (471 683) 4 532 (94) 517 (471 593) 4 576 (212) 646 (43 722)

12 Months 9 826 (164) 865 (795 92) 5 601 (259) 905 (795 92) 4 709 (159) 83 (623 933)

Discussion Is LSA effective

LSA results regardless of treatmentndash LSA successful in quantifying changes in

post op mobility

ndash Ankle fractures are significantly limiting in the geriatric population

ndash 6 weeks LS Level 1-2 (bedroomhome) with significant assistance

ndash 6 months LS Level 3-4 (neighborhoodtown) also requiring assistance

ndash 12 months Saw a loss of 1 LS Level from pre-injury status

LSA results based on treatmentndash Operatively treated patientsrsquo scores returned to

baseline while non-operative patients did not

ndash Non-op patients saw a loss of 1 LS level at 12 months

ndash Consistent with results seen in literature regarding improved results with operative management

Caveatsndash Unmatched cohorts Did not control for

confounding variables

ndash Observational conclusion

Conclusion

bull The LSA showed a significant decline in mobility in this population throughout the 12-month recovery

ndash Patients should be counseled accordinglybull Rarely left bedroom or house for first 6 weeks of recovery

bull Left neighborhood or town infrequently and with significant assistance out to 6 months

bull The LSA demonstrated an improvement in mobility in operatively managed ankle fractures albeit in an unmatched cohort

ndash Results of SF-36 Physical mirrored the LSA

ndash Operatively managed patients demonstrated slightly less pain at 12 months

bull This is an effective pilot study for future investigations utilizing the LSA within the Orthopaedic patient population

References

1 Centers for Disease and Control Prevention Home and Recreational Safety [Internet] Atlanta Centers for Disease and Control Prevention c 2014 Older Adult Falls Get the facts [cited 2014 Nov 9] Available from httpwwwcdcgovhomeandrecreationalsafetyfallsadultfallshtml

2 Sporer SM Weinstein JN Koval KJ The geographic incidence and treatment variation of common fractures of elderly patients J Am Acad Orthop Surg 200614(4)246-255

3 Bauer M Bengner U Johnell O Redlund-Johnell I Supinationeversion fractures of the ankle joint changes in incident over 30 years Foot and Ankle 826 ndash 28 1987

4 Begner U Johnell O Reblund-Johnell I Epidemiology of ankle fracture 1950 and 1980 Increasing incidence in elderly women Acta Orthop Scand 57(1)35 ndash 37 1986

5 Guggenbuhl P Meadeb J Chal`es G Osteoporotic fractures of the proximal humerus pelvis and ankle epidemiology and diagnosis Joint Bone Spine 72(5)372 ndash 375 2004

6 httpdxdoiorg101016jjbspin200404002

7 Hasselman CT Vogt MT Stone KL Cauley JA Conti SF Foot and ankle fractures in elderly white women Incidence and risk factors Journal of Bone and Joint Surgery Am 85(5)820 ndash 824 2003

8 Bariteau JT Hsu RH Mor V Lee Y DeGiovanni CW Hayda R Operative versus nonoperative treatment of geriatric ankle fractures A Medicare Part A claims database analysis Foot amp Ankle International 2015 Vol 36(6) 648ndash655

9 Peel C1 Sawyer Baker P Roth DL Brown CJ Brodner EV Allman RM Assessing mobility in older adults the UAB Study of Aging Life-Space Assessment Phys Ther 2005 Oct85(10)1008-119

10 Polku H1 Mikkola TM Portegijs E Rantakokko M Kokko K Kauppinen M Rantanen T Viljanen A Life-space mobility and dimensions of depressive symptoms among community-dwelling older adults Aging Ment Health 2015 Sep19(9)781-9 doi 101080136078632014977768 Epub 2014 Nov 7

11 Stewart CM1 Wheeler TL 2nd Markland AD Straughn JM Jr Richter HE Life-space assessment in urogynecology and gynecological oncology surgery patients a measure of perioperative mobility and function J Am Geriatr Soc 2009 Dec57(12)2263-8 doi 101111j1532-5415200902557x Epub 2009 Oct 26

12 Brown CJ1 Roth DL Allman RM Sawyer P Ritchie CS Roseman JM Trajectories of life-space mobility after hospitalization Ann Intern Med 2009 Mar 17150(6)372-8

13 Kannus P Palvanen M Niemi S Parkkari J Jarvinen M Increasing number and incidence of low-traua ankle fractures in elderly people Finnish statistics during 1970-2000 and projections for the future Bone 200231(3)430-433

14 Koval KJ Lurie J Zhou W et al Ankle fractures in the elderly what you get depends on where you live and who you see J Orthop Trauma 200519(9)635-639

15 Koval KJ Zhou W Sparks MJ Cantu RV Hecht P Lurie J Complications after ankle fracture in elderly patients Foot and Ankle International 200728(12)1249-1255 doi 103113FAI20071249

Geriatric Ankle Fractures

bull Third most common fracture in elderly

bull Ideal treatment paradigm unclear

bull Current outcome measures ineffective in assessing actual mobility ndash Floorceiling effect

ndash True deficits under reported and under appreciated

Introduction

Primary Purpose

1 Assess LSArsquos effectiveness in measuring post-injury mobility following geriatric ankle fractures

Secondary Purposes

1 To identify any differences between operative vs non-operatively managed ankle fractures

Hypothesis

ndash LSA would demonstrate

bull An effective assessment of mobility from geriatric ankle fractures

bull That geriatric ankle fractures are severely limiting

bull Operatively managed ankle fractures to have improved mobility post-op

Example Survey

Methods

bull Prospective observational study

bull Inclusion criteria

ndash Age gt 65

ndash Any type of ankle fracture

bull Treatment modality chosen by attending on patient specific basis

bull LSA administered at initial visit (pre-injury status) 6 weeks 3 months 6 months and 12 months

ndash SF-36 and VAS administered at 6 months and 12 months as current standard of care in this clinic

bull Unadjusted means calculated and compared

Conceptual drawing with average scores to reach each life space level with standard deviations

Results

Overall Non-op

Treatment

ORIF

Treatmen

t

p-value

Gender Male 520

(25)

29 (22) 311

(27)

10000

Femal

e

1520

(75)

79 (78) 811

(73)

Age 748

(62)

(n=20)

742 (73)

(n=9)

754 (54)

(n=11)

06969

Descriptive Statistics

Overall

n Mean (std) Med (Q1 Q3)

LS

Baseline 18 867 (281) 90 (80 104)

6 Week 19 207 (245) 16 (6 24)

3 Months 15 370 (344) 26 (12 80)

6 Months 10 498 (383) 453 (95 82)

12 Months 10 736 (383) 633 (46 120)

Life Space scores over time regardless of treatment

Results Non-operative

Results Operative

Results VAS amp SF-36 Physical

Overall Non-op Treatment ORIF Treatment

n Mean (std) Med (Q1 Q3) n Mean (std) Med (Q1 Q3) N Mean (Std) Med (Q1 Q3)

VAS

6 Months 9 22 (28) 1 (0 4) 4 23 (33) 1 (0 45) 5 22 (26) 1 (02 40)

12 Months 10 19 (21) 15 (0 4) 5 24 (23) 3 (0 4) 5 14 (19) 0 (0 3)

Overall Non-op Treatment ORIF Treatment

n Mean (std) Med (Q1 Q3) n Mean (std) Med (Q1 Q3) N Mean (Std) Med (Q1 Q3)

SF 36 Physical

6 Months 8 554 (153) 556 (471 683) 4 532 (94) 517 (471 593) 4 576 (212) 646 (43 722)

12 Months 9 826 (164) 865 (795 92) 5 601 (259) 905 (795 92) 4 709 (159) 83 (623 933)

Discussion Is LSA effective

LSA results regardless of treatmentndash LSA successful in quantifying changes in

post op mobility

ndash Ankle fractures are significantly limiting in the geriatric population

ndash 6 weeks LS Level 1-2 (bedroomhome) with significant assistance

ndash 6 months LS Level 3-4 (neighborhoodtown) also requiring assistance

ndash 12 months Saw a loss of 1 LS Level from pre-injury status

LSA results based on treatmentndash Operatively treated patientsrsquo scores returned to

baseline while non-operative patients did not

ndash Non-op patients saw a loss of 1 LS level at 12 months

ndash Consistent with results seen in literature regarding improved results with operative management

Caveatsndash Unmatched cohorts Did not control for

confounding variables

ndash Observational conclusion

Conclusion

bull The LSA showed a significant decline in mobility in this population throughout the 12-month recovery

ndash Patients should be counseled accordinglybull Rarely left bedroom or house for first 6 weeks of recovery

bull Left neighborhood or town infrequently and with significant assistance out to 6 months

bull The LSA demonstrated an improvement in mobility in operatively managed ankle fractures albeit in an unmatched cohort

ndash Results of SF-36 Physical mirrored the LSA

ndash Operatively managed patients demonstrated slightly less pain at 12 months

bull This is an effective pilot study for future investigations utilizing the LSA within the Orthopaedic patient population

References

1 Centers for Disease and Control Prevention Home and Recreational Safety [Internet] Atlanta Centers for Disease and Control Prevention c 2014 Older Adult Falls Get the facts [cited 2014 Nov 9] Available from httpwwwcdcgovhomeandrecreationalsafetyfallsadultfallshtml

2 Sporer SM Weinstein JN Koval KJ The geographic incidence and treatment variation of common fractures of elderly patients J Am Acad Orthop Surg 200614(4)246-255

3 Bauer M Bengner U Johnell O Redlund-Johnell I Supinationeversion fractures of the ankle joint changes in incident over 30 years Foot and Ankle 826 ndash 28 1987

4 Begner U Johnell O Reblund-Johnell I Epidemiology of ankle fracture 1950 and 1980 Increasing incidence in elderly women Acta Orthop Scand 57(1)35 ndash 37 1986

5 Guggenbuhl P Meadeb J Chal`es G Osteoporotic fractures of the proximal humerus pelvis and ankle epidemiology and diagnosis Joint Bone Spine 72(5)372 ndash 375 2004

6 httpdxdoiorg101016jjbspin200404002

7 Hasselman CT Vogt MT Stone KL Cauley JA Conti SF Foot and ankle fractures in elderly white women Incidence and risk factors Journal of Bone and Joint Surgery Am 85(5)820 ndash 824 2003

8 Bariteau JT Hsu RH Mor V Lee Y DeGiovanni CW Hayda R Operative versus nonoperative treatment of geriatric ankle fractures A Medicare Part A claims database analysis Foot amp Ankle International 2015 Vol 36(6) 648ndash655

9 Peel C1 Sawyer Baker P Roth DL Brown CJ Brodner EV Allman RM Assessing mobility in older adults the UAB Study of Aging Life-Space Assessment Phys Ther 2005 Oct85(10)1008-119

10 Polku H1 Mikkola TM Portegijs E Rantakokko M Kokko K Kauppinen M Rantanen T Viljanen A Life-space mobility and dimensions of depressive symptoms among community-dwelling older adults Aging Ment Health 2015 Sep19(9)781-9 doi 101080136078632014977768 Epub 2014 Nov 7

11 Stewart CM1 Wheeler TL 2nd Markland AD Straughn JM Jr Richter HE Life-space assessment in urogynecology and gynecological oncology surgery patients a measure of perioperative mobility and function J Am Geriatr Soc 2009 Dec57(12)2263-8 doi 101111j1532-5415200902557x Epub 2009 Oct 26

12 Brown CJ1 Roth DL Allman RM Sawyer P Ritchie CS Roseman JM Trajectories of life-space mobility after hospitalization Ann Intern Med 2009 Mar 17150(6)372-8

13 Kannus P Palvanen M Niemi S Parkkari J Jarvinen M Increasing number and incidence of low-traua ankle fractures in elderly people Finnish statistics during 1970-2000 and projections for the future Bone 200231(3)430-433

14 Koval KJ Lurie J Zhou W et al Ankle fractures in the elderly what you get depends on where you live and who you see J Orthop Trauma 200519(9)635-639

15 Koval KJ Zhou W Sparks MJ Cantu RV Hecht P Lurie J Complications after ankle fracture in elderly patients Foot and Ankle International 200728(12)1249-1255 doi 103113FAI20071249

Introduction

Primary Purpose

1 Assess LSArsquos effectiveness in measuring post-injury mobility following geriatric ankle fractures

Secondary Purposes

1 To identify any differences between operative vs non-operatively managed ankle fractures

Hypothesis

ndash LSA would demonstrate

bull An effective assessment of mobility from geriatric ankle fractures

bull That geriatric ankle fractures are severely limiting

bull Operatively managed ankle fractures to have improved mobility post-op

Example Survey

Methods

bull Prospective observational study

bull Inclusion criteria

ndash Age gt 65

ndash Any type of ankle fracture

bull Treatment modality chosen by attending on patient specific basis

bull LSA administered at initial visit (pre-injury status) 6 weeks 3 months 6 months and 12 months

ndash SF-36 and VAS administered at 6 months and 12 months as current standard of care in this clinic

bull Unadjusted means calculated and compared

Conceptual drawing with average scores to reach each life space level with standard deviations

Results

Overall Non-op

Treatment

ORIF

Treatmen

t

p-value

Gender Male 520

(25)

29 (22) 311

(27)

10000

Femal

e

1520

(75)

79 (78) 811

(73)

Age 748

(62)

(n=20)

742 (73)

(n=9)

754 (54)

(n=11)

06969

Descriptive Statistics

Overall

n Mean (std) Med (Q1 Q3)

LS

Baseline 18 867 (281) 90 (80 104)

6 Week 19 207 (245) 16 (6 24)

3 Months 15 370 (344) 26 (12 80)

6 Months 10 498 (383) 453 (95 82)

12 Months 10 736 (383) 633 (46 120)

Life Space scores over time regardless of treatment

Results Non-operative

Results Operative

Results VAS amp SF-36 Physical

Overall Non-op Treatment ORIF Treatment

n Mean (std) Med (Q1 Q3) n Mean (std) Med (Q1 Q3) N Mean (Std) Med (Q1 Q3)

VAS

6 Months 9 22 (28) 1 (0 4) 4 23 (33) 1 (0 45) 5 22 (26) 1 (02 40)

12 Months 10 19 (21) 15 (0 4) 5 24 (23) 3 (0 4) 5 14 (19) 0 (0 3)

Overall Non-op Treatment ORIF Treatment

n Mean (std) Med (Q1 Q3) n Mean (std) Med (Q1 Q3) N Mean (Std) Med (Q1 Q3)

SF 36 Physical

6 Months 8 554 (153) 556 (471 683) 4 532 (94) 517 (471 593) 4 576 (212) 646 (43 722)

12 Months 9 826 (164) 865 (795 92) 5 601 (259) 905 (795 92) 4 709 (159) 83 (623 933)

Discussion Is LSA effective

LSA results regardless of treatmentndash LSA successful in quantifying changes in

post op mobility

ndash Ankle fractures are significantly limiting in the geriatric population

ndash 6 weeks LS Level 1-2 (bedroomhome) with significant assistance

ndash 6 months LS Level 3-4 (neighborhoodtown) also requiring assistance

ndash 12 months Saw a loss of 1 LS Level from pre-injury status

LSA results based on treatmentndash Operatively treated patientsrsquo scores returned to

baseline while non-operative patients did not

ndash Non-op patients saw a loss of 1 LS level at 12 months

ndash Consistent with results seen in literature regarding improved results with operative management

Caveatsndash Unmatched cohorts Did not control for

confounding variables

ndash Observational conclusion

Conclusion

bull The LSA showed a significant decline in mobility in this population throughout the 12-month recovery

ndash Patients should be counseled accordinglybull Rarely left bedroom or house for first 6 weeks of recovery

bull Left neighborhood or town infrequently and with significant assistance out to 6 months

bull The LSA demonstrated an improvement in mobility in operatively managed ankle fractures albeit in an unmatched cohort

ndash Results of SF-36 Physical mirrored the LSA

ndash Operatively managed patients demonstrated slightly less pain at 12 months

bull This is an effective pilot study for future investigations utilizing the LSA within the Orthopaedic patient population

References

1 Centers for Disease and Control Prevention Home and Recreational Safety [Internet] Atlanta Centers for Disease and Control Prevention c 2014 Older Adult Falls Get the facts [cited 2014 Nov 9] Available from httpwwwcdcgovhomeandrecreationalsafetyfallsadultfallshtml

2 Sporer SM Weinstein JN Koval KJ The geographic incidence and treatment variation of common fractures of elderly patients J Am Acad Orthop Surg 200614(4)246-255

3 Bauer M Bengner U Johnell O Redlund-Johnell I Supinationeversion fractures of the ankle joint changes in incident over 30 years Foot and Ankle 826 ndash 28 1987

4 Begner U Johnell O Reblund-Johnell I Epidemiology of ankle fracture 1950 and 1980 Increasing incidence in elderly women Acta Orthop Scand 57(1)35 ndash 37 1986

5 Guggenbuhl P Meadeb J Chal`es G Osteoporotic fractures of the proximal humerus pelvis and ankle epidemiology and diagnosis Joint Bone Spine 72(5)372 ndash 375 2004

6 httpdxdoiorg101016jjbspin200404002

7 Hasselman CT Vogt MT Stone KL Cauley JA Conti SF Foot and ankle fractures in elderly white women Incidence and risk factors Journal of Bone and Joint Surgery Am 85(5)820 ndash 824 2003

8 Bariteau JT Hsu RH Mor V Lee Y DeGiovanni CW Hayda R Operative versus nonoperative treatment of geriatric ankle fractures A Medicare Part A claims database analysis Foot amp Ankle International 2015 Vol 36(6) 648ndash655

9 Peel C1 Sawyer Baker P Roth DL Brown CJ Brodner EV Allman RM Assessing mobility in older adults the UAB Study of Aging Life-Space Assessment Phys Ther 2005 Oct85(10)1008-119

10 Polku H1 Mikkola TM Portegijs E Rantakokko M Kokko K Kauppinen M Rantanen T Viljanen A Life-space mobility and dimensions of depressive symptoms among community-dwelling older adults Aging Ment Health 2015 Sep19(9)781-9 doi 101080136078632014977768 Epub 2014 Nov 7

11 Stewart CM1 Wheeler TL 2nd Markland AD Straughn JM Jr Richter HE Life-space assessment in urogynecology and gynecological oncology surgery patients a measure of perioperative mobility and function J Am Geriatr Soc 2009 Dec57(12)2263-8 doi 101111j1532-5415200902557x Epub 2009 Oct 26

12 Brown CJ1 Roth DL Allman RM Sawyer P Ritchie CS Roseman JM Trajectories of life-space mobility after hospitalization Ann Intern Med 2009 Mar 17150(6)372-8

13 Kannus P Palvanen M Niemi S Parkkari J Jarvinen M Increasing number and incidence of low-traua ankle fractures in elderly people Finnish statistics during 1970-2000 and projections for the future Bone 200231(3)430-433

14 Koval KJ Lurie J Zhou W et al Ankle fractures in the elderly what you get depends on where you live and who you see J Orthop Trauma 200519(9)635-639

15 Koval KJ Zhou W Sparks MJ Cantu RV Hecht P Lurie J Complications after ankle fracture in elderly patients Foot and Ankle International 200728(12)1249-1255 doi 103113FAI20071249

Methods

bull Prospective observational study

bull Inclusion criteria

ndash Age gt 65

ndash Any type of ankle fracture

bull Treatment modality chosen by attending on patient specific basis

bull LSA administered at initial visit (pre-injury status) 6 weeks 3 months 6 months and 12 months

ndash SF-36 and VAS administered at 6 months and 12 months as current standard of care in this clinic

bull Unadjusted means calculated and compared

Conceptual drawing with average scores to reach each life space level with standard deviations

Results

Overall Non-op

Treatment

ORIF

Treatmen

t

p-value

Gender Male 520

(25)

29 (22) 311

(27)

10000

Femal

e

1520

(75)

79 (78) 811

(73)

Age 748

(62)

(n=20)

742 (73)

(n=9)

754 (54)

(n=11)

06969

Descriptive Statistics

Overall

n Mean (std) Med (Q1 Q3)

LS

Baseline 18 867 (281) 90 (80 104)

6 Week 19 207 (245) 16 (6 24)

3 Months 15 370 (344) 26 (12 80)

6 Months 10 498 (383) 453 (95 82)

12 Months 10 736 (383) 633 (46 120)

Life Space scores over time regardless of treatment

Results Non-operative

Results Operative

Results VAS amp SF-36 Physical

Overall Non-op Treatment ORIF Treatment

n Mean (std) Med (Q1 Q3) n Mean (std) Med (Q1 Q3) N Mean (Std) Med (Q1 Q3)

VAS

6 Months 9 22 (28) 1 (0 4) 4 23 (33) 1 (0 45) 5 22 (26) 1 (02 40)

12 Months 10 19 (21) 15 (0 4) 5 24 (23) 3 (0 4) 5 14 (19) 0 (0 3)

Overall Non-op Treatment ORIF Treatment

n Mean (std) Med (Q1 Q3) n Mean (std) Med (Q1 Q3) N Mean (Std) Med (Q1 Q3)

SF 36 Physical

6 Months 8 554 (153) 556 (471 683) 4 532 (94) 517 (471 593) 4 576 (212) 646 (43 722)

12 Months 9 826 (164) 865 (795 92) 5 601 (259) 905 (795 92) 4 709 (159) 83 (623 933)

Discussion Is LSA effective

LSA results regardless of treatmentndash LSA successful in quantifying changes in

post op mobility

ndash Ankle fractures are significantly limiting in the geriatric population

ndash 6 weeks LS Level 1-2 (bedroomhome) with significant assistance

ndash 6 months LS Level 3-4 (neighborhoodtown) also requiring assistance

ndash 12 months Saw a loss of 1 LS Level from pre-injury status

LSA results based on treatmentndash Operatively treated patientsrsquo scores returned to

baseline while non-operative patients did not

ndash Non-op patients saw a loss of 1 LS level at 12 months

ndash Consistent with results seen in literature regarding improved results with operative management

Caveatsndash Unmatched cohorts Did not control for

confounding variables

ndash Observational conclusion

Conclusion

bull The LSA showed a significant decline in mobility in this population throughout the 12-month recovery

ndash Patients should be counseled accordinglybull Rarely left bedroom or house for first 6 weeks of recovery

bull Left neighborhood or town infrequently and with significant assistance out to 6 months

bull The LSA demonstrated an improvement in mobility in operatively managed ankle fractures albeit in an unmatched cohort

ndash Results of SF-36 Physical mirrored the LSA

ndash Operatively managed patients demonstrated slightly less pain at 12 months

bull This is an effective pilot study for future investigations utilizing the LSA within the Orthopaedic patient population

References

1 Centers for Disease and Control Prevention Home and Recreational Safety [Internet] Atlanta Centers for Disease and Control Prevention c 2014 Older Adult Falls Get the facts [cited 2014 Nov 9] Available from httpwwwcdcgovhomeandrecreationalsafetyfallsadultfallshtml

2 Sporer SM Weinstein JN Koval KJ The geographic incidence and treatment variation of common fractures of elderly patients J Am Acad Orthop Surg 200614(4)246-255

3 Bauer M Bengner U Johnell O Redlund-Johnell I Supinationeversion fractures of the ankle joint changes in incident over 30 years Foot and Ankle 826 ndash 28 1987

4 Begner U Johnell O Reblund-Johnell I Epidemiology of ankle fracture 1950 and 1980 Increasing incidence in elderly women Acta Orthop Scand 57(1)35 ndash 37 1986

5 Guggenbuhl P Meadeb J Chal`es G Osteoporotic fractures of the proximal humerus pelvis and ankle epidemiology and diagnosis Joint Bone Spine 72(5)372 ndash 375 2004

6 httpdxdoiorg101016jjbspin200404002

7 Hasselman CT Vogt MT Stone KL Cauley JA Conti SF Foot and ankle fractures in elderly white women Incidence and risk factors Journal of Bone and Joint Surgery Am 85(5)820 ndash 824 2003

8 Bariteau JT Hsu RH Mor V Lee Y DeGiovanni CW Hayda R Operative versus nonoperative treatment of geriatric ankle fractures A Medicare Part A claims database analysis Foot amp Ankle International 2015 Vol 36(6) 648ndash655

9 Peel C1 Sawyer Baker P Roth DL Brown CJ Brodner EV Allman RM Assessing mobility in older adults the UAB Study of Aging Life-Space Assessment Phys Ther 2005 Oct85(10)1008-119

10 Polku H1 Mikkola TM Portegijs E Rantakokko M Kokko K Kauppinen M Rantanen T Viljanen A Life-space mobility and dimensions of depressive symptoms among community-dwelling older adults Aging Ment Health 2015 Sep19(9)781-9 doi 101080136078632014977768 Epub 2014 Nov 7

11 Stewart CM1 Wheeler TL 2nd Markland AD Straughn JM Jr Richter HE Life-space assessment in urogynecology and gynecological oncology surgery patients a measure of perioperative mobility and function J Am Geriatr Soc 2009 Dec57(12)2263-8 doi 101111j1532-5415200902557x Epub 2009 Oct 26

12 Brown CJ1 Roth DL Allman RM Sawyer P Ritchie CS Roseman JM Trajectories of life-space mobility after hospitalization Ann Intern Med 2009 Mar 17150(6)372-8

13 Kannus P Palvanen M Niemi S Parkkari J Jarvinen M Increasing number and incidence of low-traua ankle fractures in elderly people Finnish statistics during 1970-2000 and projections for the future Bone 200231(3)430-433

14 Koval KJ Lurie J Zhou W et al Ankle fractures in the elderly what you get depends on where you live and who you see J Orthop Trauma 200519(9)635-639

15 Koval KJ Zhou W Sparks MJ Cantu RV Hecht P Lurie J Complications after ankle fracture in elderly patients Foot and Ankle International 200728(12)1249-1255 doi 103113FAI20071249

Results

Overall Non-op

Treatment

ORIF

Treatmen

t

p-value

Gender Male 520

(25)

29 (22) 311

(27)

10000

Femal

e

1520

(75)

79 (78) 811

(73)

Age 748

(62)

(n=20)

742 (73)

(n=9)

754 (54)

(n=11)

06969

Descriptive Statistics

Overall

n Mean (std) Med (Q1 Q3)

LS

Baseline 18 867 (281) 90 (80 104)

6 Week 19 207 (245) 16 (6 24)

3 Months 15 370 (344) 26 (12 80)

6 Months 10 498 (383) 453 (95 82)

12 Months 10 736 (383) 633 (46 120)

Life Space scores over time regardless of treatment

Results Non-operative

Results Operative

Results VAS amp SF-36 Physical

Overall Non-op Treatment ORIF Treatment

n Mean (std) Med (Q1 Q3) n Mean (std) Med (Q1 Q3) N Mean (Std) Med (Q1 Q3)

VAS

6 Months 9 22 (28) 1 (0 4) 4 23 (33) 1 (0 45) 5 22 (26) 1 (02 40)

12 Months 10 19 (21) 15 (0 4) 5 24 (23) 3 (0 4) 5 14 (19) 0 (0 3)

Overall Non-op Treatment ORIF Treatment

n Mean (std) Med (Q1 Q3) n Mean (std) Med (Q1 Q3) N Mean (Std) Med (Q1 Q3)

SF 36 Physical

6 Months 8 554 (153) 556 (471 683) 4 532 (94) 517 (471 593) 4 576 (212) 646 (43 722)

12 Months 9 826 (164) 865 (795 92) 5 601 (259) 905 (795 92) 4 709 (159) 83 (623 933)

Discussion Is LSA effective

LSA results regardless of treatmentndash LSA successful in quantifying changes in

post op mobility

ndash Ankle fractures are significantly limiting in the geriatric population

ndash 6 weeks LS Level 1-2 (bedroomhome) with significant assistance

ndash 6 months LS Level 3-4 (neighborhoodtown) also requiring assistance

ndash 12 months Saw a loss of 1 LS Level from pre-injury status

LSA results based on treatmentndash Operatively treated patientsrsquo scores returned to

baseline while non-operative patients did not

ndash Non-op patients saw a loss of 1 LS level at 12 months

ndash Consistent with results seen in literature regarding improved results with operative management

Caveatsndash Unmatched cohorts Did not control for

confounding variables

ndash Observational conclusion

Conclusion

bull The LSA showed a significant decline in mobility in this population throughout the 12-month recovery

ndash Patients should be counseled accordinglybull Rarely left bedroom or house for first 6 weeks of recovery

bull Left neighborhood or town infrequently and with significant assistance out to 6 months

bull The LSA demonstrated an improvement in mobility in operatively managed ankle fractures albeit in an unmatched cohort

ndash Results of SF-36 Physical mirrored the LSA

ndash Operatively managed patients demonstrated slightly less pain at 12 months

bull This is an effective pilot study for future investigations utilizing the LSA within the Orthopaedic patient population

References

1 Centers for Disease and Control Prevention Home and Recreational Safety [Internet] Atlanta Centers for Disease and Control Prevention c 2014 Older Adult Falls Get the facts [cited 2014 Nov 9] Available from httpwwwcdcgovhomeandrecreationalsafetyfallsadultfallshtml

2 Sporer SM Weinstein JN Koval KJ The geographic incidence and treatment variation of common fractures of elderly patients J Am Acad Orthop Surg 200614(4)246-255

3 Bauer M Bengner U Johnell O Redlund-Johnell I Supinationeversion fractures of the ankle joint changes in incident over 30 years Foot and Ankle 826 ndash 28 1987

4 Begner U Johnell O Reblund-Johnell I Epidemiology of ankle fracture 1950 and 1980 Increasing incidence in elderly women Acta Orthop Scand 57(1)35 ndash 37 1986

5 Guggenbuhl P Meadeb J Chal`es G Osteoporotic fractures of the proximal humerus pelvis and ankle epidemiology and diagnosis Joint Bone Spine 72(5)372 ndash 375 2004

6 httpdxdoiorg101016jjbspin200404002

7 Hasselman CT Vogt MT Stone KL Cauley JA Conti SF Foot and ankle fractures in elderly white women Incidence and risk factors Journal of Bone and Joint Surgery Am 85(5)820 ndash 824 2003

8 Bariteau JT Hsu RH Mor V Lee Y DeGiovanni CW Hayda R Operative versus nonoperative treatment of geriatric ankle fractures A Medicare Part A claims database analysis Foot amp Ankle International 2015 Vol 36(6) 648ndash655

9 Peel C1 Sawyer Baker P Roth DL Brown CJ Brodner EV Allman RM Assessing mobility in older adults the UAB Study of Aging Life-Space Assessment Phys Ther 2005 Oct85(10)1008-119

10 Polku H1 Mikkola TM Portegijs E Rantakokko M Kokko K Kauppinen M Rantanen T Viljanen A Life-space mobility and dimensions of depressive symptoms among community-dwelling older adults Aging Ment Health 2015 Sep19(9)781-9 doi 101080136078632014977768 Epub 2014 Nov 7

11 Stewart CM1 Wheeler TL 2nd Markland AD Straughn JM Jr Richter HE Life-space assessment in urogynecology and gynecological oncology surgery patients a measure of perioperative mobility and function J Am Geriatr Soc 2009 Dec57(12)2263-8 doi 101111j1532-5415200902557x Epub 2009 Oct 26

12 Brown CJ1 Roth DL Allman RM Sawyer P Ritchie CS Roseman JM Trajectories of life-space mobility after hospitalization Ann Intern Med 2009 Mar 17150(6)372-8

13 Kannus P Palvanen M Niemi S Parkkari J Jarvinen M Increasing number and incidence of low-traua ankle fractures in elderly people Finnish statistics during 1970-2000 and projections for the future Bone 200231(3)430-433

14 Koval KJ Lurie J Zhou W et al Ankle fractures in the elderly what you get depends on where you live and who you see J Orthop Trauma 200519(9)635-639

15 Koval KJ Zhou W Sparks MJ Cantu RV Hecht P Lurie J Complications after ankle fracture in elderly patients Foot and Ankle International 200728(12)1249-1255 doi 103113FAI20071249

Results Non-operative

Results Operative

Results VAS amp SF-36 Physical

Overall Non-op Treatment ORIF Treatment

n Mean (std) Med (Q1 Q3) n Mean (std) Med (Q1 Q3) N Mean (Std) Med (Q1 Q3)

VAS

6 Months 9 22 (28) 1 (0 4) 4 23 (33) 1 (0 45) 5 22 (26) 1 (02 40)

12 Months 10 19 (21) 15 (0 4) 5 24 (23) 3 (0 4) 5 14 (19) 0 (0 3)

Overall Non-op Treatment ORIF Treatment

n Mean (std) Med (Q1 Q3) n Mean (std) Med (Q1 Q3) N Mean (Std) Med (Q1 Q3)

SF 36 Physical

6 Months 8 554 (153) 556 (471 683) 4 532 (94) 517 (471 593) 4 576 (212) 646 (43 722)

12 Months 9 826 (164) 865 (795 92) 5 601 (259) 905 (795 92) 4 709 (159) 83 (623 933)

Discussion Is LSA effective

LSA results regardless of treatmentndash LSA successful in quantifying changes in

post op mobility

ndash Ankle fractures are significantly limiting in the geriatric population

ndash 6 weeks LS Level 1-2 (bedroomhome) with significant assistance

ndash 6 months LS Level 3-4 (neighborhoodtown) also requiring assistance

ndash 12 months Saw a loss of 1 LS Level from pre-injury status

LSA results based on treatmentndash Operatively treated patientsrsquo scores returned to

baseline while non-operative patients did not

ndash Non-op patients saw a loss of 1 LS level at 12 months

ndash Consistent with results seen in literature regarding improved results with operative management

Caveatsndash Unmatched cohorts Did not control for

confounding variables

ndash Observational conclusion

Conclusion

bull The LSA showed a significant decline in mobility in this population throughout the 12-month recovery

ndash Patients should be counseled accordinglybull Rarely left bedroom or house for first 6 weeks of recovery

bull Left neighborhood or town infrequently and with significant assistance out to 6 months

bull The LSA demonstrated an improvement in mobility in operatively managed ankle fractures albeit in an unmatched cohort

ndash Results of SF-36 Physical mirrored the LSA

ndash Operatively managed patients demonstrated slightly less pain at 12 months

bull This is an effective pilot study for future investigations utilizing the LSA within the Orthopaedic patient population

References

1 Centers for Disease and Control Prevention Home and Recreational Safety [Internet] Atlanta Centers for Disease and Control Prevention c 2014 Older Adult Falls Get the facts [cited 2014 Nov 9] Available from httpwwwcdcgovhomeandrecreationalsafetyfallsadultfallshtml

2 Sporer SM Weinstein JN Koval KJ The geographic incidence and treatment variation of common fractures of elderly patients J Am Acad Orthop Surg 200614(4)246-255

3 Bauer M Bengner U Johnell O Redlund-Johnell I Supinationeversion fractures of the ankle joint changes in incident over 30 years Foot and Ankle 826 ndash 28 1987

4 Begner U Johnell O Reblund-Johnell I Epidemiology of ankle fracture 1950 and 1980 Increasing incidence in elderly women Acta Orthop Scand 57(1)35 ndash 37 1986

5 Guggenbuhl P Meadeb J Chal`es G Osteoporotic fractures of the proximal humerus pelvis and ankle epidemiology and diagnosis Joint Bone Spine 72(5)372 ndash 375 2004

6 httpdxdoiorg101016jjbspin200404002

7 Hasselman CT Vogt MT Stone KL Cauley JA Conti SF Foot and ankle fractures in elderly white women Incidence and risk factors Journal of Bone and Joint Surgery Am 85(5)820 ndash 824 2003

8 Bariteau JT Hsu RH Mor V Lee Y DeGiovanni CW Hayda R Operative versus nonoperative treatment of geriatric ankle fractures A Medicare Part A claims database analysis Foot amp Ankle International 2015 Vol 36(6) 648ndash655

9 Peel C1 Sawyer Baker P Roth DL Brown CJ Brodner EV Allman RM Assessing mobility in older adults the UAB Study of Aging Life-Space Assessment Phys Ther 2005 Oct85(10)1008-119

10 Polku H1 Mikkola TM Portegijs E Rantakokko M Kokko K Kauppinen M Rantanen T Viljanen A Life-space mobility and dimensions of depressive symptoms among community-dwelling older adults Aging Ment Health 2015 Sep19(9)781-9 doi 101080136078632014977768 Epub 2014 Nov 7

11 Stewart CM1 Wheeler TL 2nd Markland AD Straughn JM Jr Richter HE Life-space assessment in urogynecology and gynecological oncology surgery patients a measure of perioperative mobility and function J Am Geriatr Soc 2009 Dec57(12)2263-8 doi 101111j1532-5415200902557x Epub 2009 Oct 26

12 Brown CJ1 Roth DL Allman RM Sawyer P Ritchie CS Roseman JM Trajectories of life-space mobility after hospitalization Ann Intern Med 2009 Mar 17150(6)372-8

13 Kannus P Palvanen M Niemi S Parkkari J Jarvinen M Increasing number and incidence of low-traua ankle fractures in elderly people Finnish statistics during 1970-2000 and projections for the future Bone 200231(3)430-433

14 Koval KJ Lurie J Zhou W et al Ankle fractures in the elderly what you get depends on where you live and who you see J Orthop Trauma 200519(9)635-639

15 Koval KJ Zhou W Sparks MJ Cantu RV Hecht P Lurie J Complications after ankle fracture in elderly patients Foot and Ankle International 200728(12)1249-1255 doi 103113FAI20071249

Results Operative

Results VAS amp SF-36 Physical

Overall Non-op Treatment ORIF Treatment

n Mean (std) Med (Q1 Q3) n Mean (std) Med (Q1 Q3) N Mean (Std) Med (Q1 Q3)

VAS

6 Months 9 22 (28) 1 (0 4) 4 23 (33) 1 (0 45) 5 22 (26) 1 (02 40)

12 Months 10 19 (21) 15 (0 4) 5 24 (23) 3 (0 4) 5 14 (19) 0 (0 3)

Overall Non-op Treatment ORIF Treatment

n Mean (std) Med (Q1 Q3) n Mean (std) Med (Q1 Q3) N Mean (Std) Med (Q1 Q3)

SF 36 Physical

6 Months 8 554 (153) 556 (471 683) 4 532 (94) 517 (471 593) 4 576 (212) 646 (43 722)

12 Months 9 826 (164) 865 (795 92) 5 601 (259) 905 (795 92) 4 709 (159) 83 (623 933)

Discussion Is LSA effective

LSA results regardless of treatmentndash LSA successful in quantifying changes in

post op mobility

ndash Ankle fractures are significantly limiting in the geriatric population

ndash 6 weeks LS Level 1-2 (bedroomhome) with significant assistance

ndash 6 months LS Level 3-4 (neighborhoodtown) also requiring assistance

ndash 12 months Saw a loss of 1 LS Level from pre-injury status

LSA results based on treatmentndash Operatively treated patientsrsquo scores returned to

baseline while non-operative patients did not

ndash Non-op patients saw a loss of 1 LS level at 12 months

ndash Consistent with results seen in literature regarding improved results with operative management

Caveatsndash Unmatched cohorts Did not control for

confounding variables

ndash Observational conclusion

Conclusion

bull The LSA showed a significant decline in mobility in this population throughout the 12-month recovery

ndash Patients should be counseled accordinglybull Rarely left bedroom or house for first 6 weeks of recovery

bull Left neighborhood or town infrequently and with significant assistance out to 6 months

bull The LSA demonstrated an improvement in mobility in operatively managed ankle fractures albeit in an unmatched cohort

ndash Results of SF-36 Physical mirrored the LSA

ndash Operatively managed patients demonstrated slightly less pain at 12 months

bull This is an effective pilot study for future investigations utilizing the LSA within the Orthopaedic patient population

References

1 Centers for Disease and Control Prevention Home and Recreational Safety [Internet] Atlanta Centers for Disease and Control Prevention c 2014 Older Adult Falls Get the facts [cited 2014 Nov 9] Available from httpwwwcdcgovhomeandrecreationalsafetyfallsadultfallshtml

2 Sporer SM Weinstein JN Koval KJ The geographic incidence and treatment variation of common fractures of elderly patients J Am Acad Orthop Surg 200614(4)246-255

3 Bauer M Bengner U Johnell O Redlund-Johnell I Supinationeversion fractures of the ankle joint changes in incident over 30 years Foot and Ankle 826 ndash 28 1987

4 Begner U Johnell O Reblund-Johnell I Epidemiology of ankle fracture 1950 and 1980 Increasing incidence in elderly women Acta Orthop Scand 57(1)35 ndash 37 1986

5 Guggenbuhl P Meadeb J Chal`es G Osteoporotic fractures of the proximal humerus pelvis and ankle epidemiology and diagnosis Joint Bone Spine 72(5)372 ndash 375 2004

6 httpdxdoiorg101016jjbspin200404002

7 Hasselman CT Vogt MT Stone KL Cauley JA Conti SF Foot and ankle fractures in elderly white women Incidence and risk factors Journal of Bone and Joint Surgery Am 85(5)820 ndash 824 2003

8 Bariteau JT Hsu RH Mor V Lee Y DeGiovanni CW Hayda R Operative versus nonoperative treatment of geriatric ankle fractures A Medicare Part A claims database analysis Foot amp Ankle International 2015 Vol 36(6) 648ndash655

9 Peel C1 Sawyer Baker P Roth DL Brown CJ Brodner EV Allman RM Assessing mobility in older adults the UAB Study of Aging Life-Space Assessment Phys Ther 2005 Oct85(10)1008-119

10 Polku H1 Mikkola TM Portegijs E Rantakokko M Kokko K Kauppinen M Rantanen T Viljanen A Life-space mobility and dimensions of depressive symptoms among community-dwelling older adults Aging Ment Health 2015 Sep19(9)781-9 doi 101080136078632014977768 Epub 2014 Nov 7

11 Stewart CM1 Wheeler TL 2nd Markland AD Straughn JM Jr Richter HE Life-space assessment in urogynecology and gynecological oncology surgery patients a measure of perioperative mobility and function J Am Geriatr Soc 2009 Dec57(12)2263-8 doi 101111j1532-5415200902557x Epub 2009 Oct 26

12 Brown CJ1 Roth DL Allman RM Sawyer P Ritchie CS Roseman JM Trajectories of life-space mobility after hospitalization Ann Intern Med 2009 Mar 17150(6)372-8

13 Kannus P Palvanen M Niemi S Parkkari J Jarvinen M Increasing number and incidence of low-traua ankle fractures in elderly people Finnish statistics during 1970-2000 and projections for the future Bone 200231(3)430-433

14 Koval KJ Lurie J Zhou W et al Ankle fractures in the elderly what you get depends on where you live and who you see J Orthop Trauma 200519(9)635-639

15 Koval KJ Zhou W Sparks MJ Cantu RV Hecht P Lurie J Complications after ankle fracture in elderly patients Foot and Ankle International 200728(12)1249-1255 doi 103113FAI20071249

Results VAS amp SF-36 Physical

Overall Non-op Treatment ORIF Treatment

n Mean (std) Med (Q1 Q3) n Mean (std) Med (Q1 Q3) N Mean (Std) Med (Q1 Q3)

VAS

6 Months 9 22 (28) 1 (0 4) 4 23 (33) 1 (0 45) 5 22 (26) 1 (02 40)

12 Months 10 19 (21) 15 (0 4) 5 24 (23) 3 (0 4) 5 14 (19) 0 (0 3)

Overall Non-op Treatment ORIF Treatment

n Mean (std) Med (Q1 Q3) n Mean (std) Med (Q1 Q3) N Mean (Std) Med (Q1 Q3)

SF 36 Physical

6 Months 8 554 (153) 556 (471 683) 4 532 (94) 517 (471 593) 4 576 (212) 646 (43 722)

12 Months 9 826 (164) 865 (795 92) 5 601 (259) 905 (795 92) 4 709 (159) 83 (623 933)

Discussion Is LSA effective

LSA results regardless of treatmentndash LSA successful in quantifying changes in

post op mobility

ndash Ankle fractures are significantly limiting in the geriatric population

ndash 6 weeks LS Level 1-2 (bedroomhome) with significant assistance

ndash 6 months LS Level 3-4 (neighborhoodtown) also requiring assistance

ndash 12 months Saw a loss of 1 LS Level from pre-injury status

LSA results based on treatmentndash Operatively treated patientsrsquo scores returned to

baseline while non-operative patients did not

ndash Non-op patients saw a loss of 1 LS level at 12 months

ndash Consistent with results seen in literature regarding improved results with operative management

Caveatsndash Unmatched cohorts Did not control for

confounding variables

ndash Observational conclusion

Conclusion

bull The LSA showed a significant decline in mobility in this population throughout the 12-month recovery

ndash Patients should be counseled accordinglybull Rarely left bedroom or house for first 6 weeks of recovery

bull Left neighborhood or town infrequently and with significant assistance out to 6 months

bull The LSA demonstrated an improvement in mobility in operatively managed ankle fractures albeit in an unmatched cohort

ndash Results of SF-36 Physical mirrored the LSA

ndash Operatively managed patients demonstrated slightly less pain at 12 months

bull This is an effective pilot study for future investigations utilizing the LSA within the Orthopaedic patient population

References

1 Centers for Disease and Control Prevention Home and Recreational Safety [Internet] Atlanta Centers for Disease and Control Prevention c 2014 Older Adult Falls Get the facts [cited 2014 Nov 9] Available from httpwwwcdcgovhomeandrecreationalsafetyfallsadultfallshtml

2 Sporer SM Weinstein JN Koval KJ The geographic incidence and treatment variation of common fractures of elderly patients J Am Acad Orthop Surg 200614(4)246-255

3 Bauer M Bengner U Johnell O Redlund-Johnell I Supinationeversion fractures of the ankle joint changes in incident over 30 years Foot and Ankle 826 ndash 28 1987

4 Begner U Johnell O Reblund-Johnell I Epidemiology of ankle fracture 1950 and 1980 Increasing incidence in elderly women Acta Orthop Scand 57(1)35 ndash 37 1986

5 Guggenbuhl P Meadeb J Chal`es G Osteoporotic fractures of the proximal humerus pelvis and ankle epidemiology and diagnosis Joint Bone Spine 72(5)372 ndash 375 2004

6 httpdxdoiorg101016jjbspin200404002

7 Hasselman CT Vogt MT Stone KL Cauley JA Conti SF Foot and ankle fractures in elderly white women Incidence and risk factors Journal of Bone and Joint Surgery Am 85(5)820 ndash 824 2003

8 Bariteau JT Hsu RH Mor V Lee Y DeGiovanni CW Hayda R Operative versus nonoperative treatment of geriatric ankle fractures A Medicare Part A claims database analysis Foot amp Ankle International 2015 Vol 36(6) 648ndash655

9 Peel C1 Sawyer Baker P Roth DL Brown CJ Brodner EV Allman RM Assessing mobility in older adults the UAB Study of Aging Life-Space Assessment Phys Ther 2005 Oct85(10)1008-119

10 Polku H1 Mikkola TM Portegijs E Rantakokko M Kokko K Kauppinen M Rantanen T Viljanen A Life-space mobility and dimensions of depressive symptoms among community-dwelling older adults Aging Ment Health 2015 Sep19(9)781-9 doi 101080136078632014977768 Epub 2014 Nov 7

11 Stewart CM1 Wheeler TL 2nd Markland AD Straughn JM Jr Richter HE Life-space assessment in urogynecology and gynecological oncology surgery patients a measure of perioperative mobility and function J Am Geriatr Soc 2009 Dec57(12)2263-8 doi 101111j1532-5415200902557x Epub 2009 Oct 26

12 Brown CJ1 Roth DL Allman RM Sawyer P Ritchie CS Roseman JM Trajectories of life-space mobility after hospitalization Ann Intern Med 2009 Mar 17150(6)372-8

13 Kannus P Palvanen M Niemi S Parkkari J Jarvinen M Increasing number and incidence of low-traua ankle fractures in elderly people Finnish statistics during 1970-2000 and projections for the future Bone 200231(3)430-433

14 Koval KJ Lurie J Zhou W et al Ankle fractures in the elderly what you get depends on where you live and who you see J Orthop Trauma 200519(9)635-639

15 Koval KJ Zhou W Sparks MJ Cantu RV Hecht P Lurie J Complications after ankle fracture in elderly patients Foot and Ankle International 200728(12)1249-1255 doi 103113FAI20071249

Discussion Is LSA effective

LSA results regardless of treatmentndash LSA successful in quantifying changes in

post op mobility

ndash Ankle fractures are significantly limiting in the geriatric population

ndash 6 weeks LS Level 1-2 (bedroomhome) with significant assistance

ndash 6 months LS Level 3-4 (neighborhoodtown) also requiring assistance

ndash 12 months Saw a loss of 1 LS Level from pre-injury status

LSA results based on treatmentndash Operatively treated patientsrsquo scores returned to

baseline while non-operative patients did not

ndash Non-op patients saw a loss of 1 LS level at 12 months

ndash Consistent with results seen in literature regarding improved results with operative management

Caveatsndash Unmatched cohorts Did not control for

confounding variables

ndash Observational conclusion

Conclusion

bull The LSA showed a significant decline in mobility in this population throughout the 12-month recovery

ndash Patients should be counseled accordinglybull Rarely left bedroom or house for first 6 weeks of recovery

bull Left neighborhood or town infrequently and with significant assistance out to 6 months

bull The LSA demonstrated an improvement in mobility in operatively managed ankle fractures albeit in an unmatched cohort

ndash Results of SF-36 Physical mirrored the LSA

ndash Operatively managed patients demonstrated slightly less pain at 12 months

bull This is an effective pilot study for future investigations utilizing the LSA within the Orthopaedic patient population

References

1 Centers for Disease and Control Prevention Home and Recreational Safety [Internet] Atlanta Centers for Disease and Control Prevention c 2014 Older Adult Falls Get the facts [cited 2014 Nov 9] Available from httpwwwcdcgovhomeandrecreationalsafetyfallsadultfallshtml

2 Sporer SM Weinstein JN Koval KJ The geographic incidence and treatment variation of common fractures of elderly patients J Am Acad Orthop Surg 200614(4)246-255

3 Bauer M Bengner U Johnell O Redlund-Johnell I Supinationeversion fractures of the ankle joint changes in incident over 30 years Foot and Ankle 826 ndash 28 1987

4 Begner U Johnell O Reblund-Johnell I Epidemiology of ankle fracture 1950 and 1980 Increasing incidence in elderly women Acta Orthop Scand 57(1)35 ndash 37 1986

5 Guggenbuhl P Meadeb J Chal`es G Osteoporotic fractures of the proximal humerus pelvis and ankle epidemiology and diagnosis Joint Bone Spine 72(5)372 ndash 375 2004

6 httpdxdoiorg101016jjbspin200404002

7 Hasselman CT Vogt MT Stone KL Cauley JA Conti SF Foot and ankle fractures in elderly white women Incidence and risk factors Journal of Bone and Joint Surgery Am 85(5)820 ndash 824 2003

8 Bariteau JT Hsu RH Mor V Lee Y DeGiovanni CW Hayda R Operative versus nonoperative treatment of geriatric ankle fractures A Medicare Part A claims database analysis Foot amp Ankle International 2015 Vol 36(6) 648ndash655

9 Peel C1 Sawyer Baker P Roth DL Brown CJ Brodner EV Allman RM Assessing mobility in older adults the UAB Study of Aging Life-Space Assessment Phys Ther 2005 Oct85(10)1008-119

10 Polku H1 Mikkola TM Portegijs E Rantakokko M Kokko K Kauppinen M Rantanen T Viljanen A Life-space mobility and dimensions of depressive symptoms among community-dwelling older adults Aging Ment Health 2015 Sep19(9)781-9 doi 101080136078632014977768 Epub 2014 Nov 7

11 Stewart CM1 Wheeler TL 2nd Markland AD Straughn JM Jr Richter HE Life-space assessment in urogynecology and gynecological oncology surgery patients a measure of perioperative mobility and function J Am Geriatr Soc 2009 Dec57(12)2263-8 doi 101111j1532-5415200902557x Epub 2009 Oct 26

12 Brown CJ1 Roth DL Allman RM Sawyer P Ritchie CS Roseman JM Trajectories of life-space mobility after hospitalization Ann Intern Med 2009 Mar 17150(6)372-8

13 Kannus P Palvanen M Niemi S Parkkari J Jarvinen M Increasing number and incidence of low-traua ankle fractures in elderly people Finnish statistics during 1970-2000 and projections for the future Bone 200231(3)430-433

14 Koval KJ Lurie J Zhou W et al Ankle fractures in the elderly what you get depends on where you live and who you see J Orthop Trauma 200519(9)635-639

15 Koval KJ Zhou W Sparks MJ Cantu RV Hecht P Lurie J Complications after ankle fracture in elderly patients Foot and Ankle International 200728(12)1249-1255 doi 103113FAI20071249

Conclusion

bull The LSA showed a significant decline in mobility in this population throughout the 12-month recovery

ndash Patients should be counseled accordinglybull Rarely left bedroom or house for first 6 weeks of recovery

bull Left neighborhood or town infrequently and with significant assistance out to 6 months

bull The LSA demonstrated an improvement in mobility in operatively managed ankle fractures albeit in an unmatched cohort

ndash Results of SF-36 Physical mirrored the LSA

ndash Operatively managed patients demonstrated slightly less pain at 12 months

bull This is an effective pilot study for future investigations utilizing the LSA within the Orthopaedic patient population

References

1 Centers for Disease and Control Prevention Home and Recreational Safety [Internet] Atlanta Centers for Disease and Control Prevention c 2014 Older Adult Falls Get the facts [cited 2014 Nov 9] Available from httpwwwcdcgovhomeandrecreationalsafetyfallsadultfallshtml

2 Sporer SM Weinstein JN Koval KJ The geographic incidence and treatment variation of common fractures of elderly patients J Am Acad Orthop Surg 200614(4)246-255

3 Bauer M Bengner U Johnell O Redlund-Johnell I Supinationeversion fractures of the ankle joint changes in incident over 30 years Foot and Ankle 826 ndash 28 1987

4 Begner U Johnell O Reblund-Johnell I Epidemiology of ankle fracture 1950 and 1980 Increasing incidence in elderly women Acta Orthop Scand 57(1)35 ndash 37 1986

5 Guggenbuhl P Meadeb J Chal`es G Osteoporotic fractures of the proximal humerus pelvis and ankle epidemiology and diagnosis Joint Bone Spine 72(5)372 ndash 375 2004

6 httpdxdoiorg101016jjbspin200404002

7 Hasselman CT Vogt MT Stone KL Cauley JA Conti SF Foot and ankle fractures in elderly white women Incidence and risk factors Journal of Bone and Joint Surgery Am 85(5)820 ndash 824 2003

8 Bariteau JT Hsu RH Mor V Lee Y DeGiovanni CW Hayda R Operative versus nonoperative treatment of geriatric ankle fractures A Medicare Part A claims database analysis Foot amp Ankle International 2015 Vol 36(6) 648ndash655

9 Peel C1 Sawyer Baker P Roth DL Brown CJ Brodner EV Allman RM Assessing mobility in older adults the UAB Study of Aging Life-Space Assessment Phys Ther 2005 Oct85(10)1008-119

10 Polku H1 Mikkola TM Portegijs E Rantakokko M Kokko K Kauppinen M Rantanen T Viljanen A Life-space mobility and dimensions of depressive symptoms among community-dwelling older adults Aging Ment Health 2015 Sep19(9)781-9 doi 101080136078632014977768 Epub 2014 Nov 7

11 Stewart CM1 Wheeler TL 2nd Markland AD Straughn JM Jr Richter HE Life-space assessment in urogynecology and gynecological oncology surgery patients a measure of perioperative mobility and function J Am Geriatr Soc 2009 Dec57(12)2263-8 doi 101111j1532-5415200902557x Epub 2009 Oct 26

12 Brown CJ1 Roth DL Allman RM Sawyer P Ritchie CS Roseman JM Trajectories of life-space mobility after hospitalization Ann Intern Med 2009 Mar 17150(6)372-8

13 Kannus P Palvanen M Niemi S Parkkari J Jarvinen M Increasing number and incidence of low-traua ankle fractures in elderly people Finnish statistics during 1970-2000 and projections for the future Bone 200231(3)430-433

14 Koval KJ Lurie J Zhou W et al Ankle fractures in the elderly what you get depends on where you live and who you see J Orthop Trauma 200519(9)635-639

15 Koval KJ Zhou W Sparks MJ Cantu RV Hecht P Lurie J Complications after ankle fracture in elderly patients Foot and Ankle International 200728(12)1249-1255 doi 103113FAI20071249

References

1 Centers for Disease and Control Prevention Home and Recreational Safety [Internet] Atlanta Centers for Disease and Control Prevention c 2014 Older Adult Falls Get the facts [cited 2014 Nov 9] Available from httpwwwcdcgovhomeandrecreationalsafetyfallsadultfallshtml

2 Sporer SM Weinstein JN Koval KJ The geographic incidence and treatment variation of common fractures of elderly patients J Am Acad Orthop Surg 200614(4)246-255

3 Bauer M Bengner U Johnell O Redlund-Johnell I Supinationeversion fractures of the ankle joint changes in incident over 30 years Foot and Ankle 826 ndash 28 1987

4 Begner U Johnell O Reblund-Johnell I Epidemiology of ankle fracture 1950 and 1980 Increasing incidence in elderly women Acta Orthop Scand 57(1)35 ndash 37 1986

5 Guggenbuhl P Meadeb J Chal`es G Osteoporotic fractures of the proximal humerus pelvis and ankle epidemiology and diagnosis Joint Bone Spine 72(5)372 ndash 375 2004

6 httpdxdoiorg101016jjbspin200404002

7 Hasselman CT Vogt MT Stone KL Cauley JA Conti SF Foot and ankle fractures in elderly white women Incidence and risk factors Journal of Bone and Joint Surgery Am 85(5)820 ndash 824 2003

8 Bariteau JT Hsu RH Mor V Lee Y DeGiovanni CW Hayda R Operative versus nonoperative treatment of geriatric ankle fractures A Medicare Part A claims database analysis Foot amp Ankle International 2015 Vol 36(6) 648ndash655

9 Peel C1 Sawyer Baker P Roth DL Brown CJ Brodner EV Allman RM Assessing mobility in older adults the UAB Study of Aging Life-Space Assessment Phys Ther 2005 Oct85(10)1008-119

10 Polku H1 Mikkola TM Portegijs E Rantakokko M Kokko K Kauppinen M Rantanen T Viljanen A Life-space mobility and dimensions of depressive symptoms among community-dwelling older adults Aging Ment Health 2015 Sep19(9)781-9 doi 101080136078632014977768 Epub 2014 Nov 7

11 Stewart CM1 Wheeler TL 2nd Markland AD Straughn JM Jr Richter HE Life-space assessment in urogynecology and gynecological oncology surgery patients a measure of perioperative mobility and function J Am Geriatr Soc 2009 Dec57(12)2263-8 doi 101111j1532-5415200902557x Epub 2009 Oct 26

12 Brown CJ1 Roth DL Allman RM Sawyer P Ritchie CS Roseman JM Trajectories of life-space mobility after hospitalization Ann Intern Med 2009 Mar 17150(6)372-8

13 Kannus P Palvanen M Niemi S Parkkari J Jarvinen M Increasing number and incidence of low-traua ankle fractures in elderly people Finnish statistics during 1970-2000 and projections for the future Bone 200231(3)430-433

14 Koval KJ Lurie J Zhou W et al Ankle fractures in the elderly what you get depends on where you live and who you see J Orthop Trauma 200519(9)635-639

15 Koval KJ Zhou W Sparks MJ Cantu RV Hecht P Lurie J Complications after ankle fracture in elderly patients Foot and Ankle International 200728(12)1249-1255 doi 103113FAI20071249