Open Tib/Fib Fractures in the Elderly: A Distinct Injury Requiring Different Management

Description

This presentation, delivered by Grant Nolan, a core surgical trainee from Northwest, focuses on open tibia/fibula fractures in the elderly, drawing insights from research conducted at St Mary's Hospital in London. Nolan begins with an overview of the increase in traumatic injuries among the 65 and over demographic in the UK, which has doubled from 2008 to 2016, yet remains an under-researched area. The current guidelines on managing open tibia fractures are noted to be general and skewed towards high-energy injuries common in younger patients.



The study involves a cohort of patients treated for open lower limb fractures between December 2015 and July 2018, adhering to a strict criterion for patient selection (age 65+ and one year follow-up). The findings illustrate a bimodal distribution of fractures, with a higher proportion of high-energy injuries in younger individuals compared to the elderly, though the degree of soft tissue damage remains comparable across both groups. Nolan highlights that while most open tibia fractures in males are from high-energy impacts, low-energy injuries are prevalent among female patients.



The discussion also touches on treatment protocols, duration of hospital stays, and surgical interventions undertaken, revealing that elderly patients experienced longer recovery times. Despite demographic and energy profile differences, outcomes related to soft tissue injuries and complications were similar between the two cohorts. Nolan emphasizes the need to treat elderly patients with the same urgency and care as younger individuals, advocating for updated guidelines tailored to the elderly. He concludes by suggesting future research into enhanced care pathways to improve rehabilitation and discharge rates, and expresses readiness to answer questions from the audience.

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