Devices Surgery Orthopaedic

 News Release - March 23, 2006

Ankle Ailments Get a 'Leg up' with New Treatments and Techniques

In Step With Orthopaedic Advancements in Treating Fractures and Arthritis of the Ankle

CHICAGO, March 23 (HSMN NewsFeed) -- Older adults are at higher risk for ankle-related injuries and fractures because they lose muscle mass, bone strength and vision acuity as they age. These physiological changes adversely affect their balance and increase their likelihood for accidental falls. However, even younger patients are susceptible to debilitating ankle arthritis -- most commonly caused by a previous injury such as a fracture, bad sprain or overuse -- which worsens over time. The best approaches to treating ankle fractures in the elderly and the newest surgical options for ankle arthritis in younger and older patients were discussed today at the 73rd Annual Meeting of the American Academy of Orthopaedic Surgeons in Chicago.

Ankle fractures: operate or not?

A broken ankle is a common injury among people over age 60, but whether to operate on severe ankle fractures in this age group or to put the ankle in a cast is unclear. Now a new study shows that patients ages 60 and older who have surgery to repair unstable, or severe, ankle fractures do not have worse functional outcomes than younger patients, as some past research has shown.

"Our data show those over 60 do just as well clinically as younger people one year after surgery, with few complications," said Kenneth A. Egol, MD, study co-author and chief of orthopaedic trauma service at New York University-Hospital for Joint Diseases. "However, self-reported functional results fall below that of patients younger than 60."

"We need to treat our elderly patients with ankle fractures the same as younger patients," Dr. Egol stressed. "This study gives support to the current practice of aggressive treatment for unstable ankle fractures, so patients can return to their pre-injury function."

Unstable fractures -- those with injury to both sides of the ankle -- require surgery to fix the joint so it will heal properly. Unlike surgical treatment of Hip Fractures in the elderly, which is considered standard therapy, surgical repair of ankle fractures in older patients is debated, Dr. Egol said. Some doctors believe that age-related illnesses, such as osteoporosis, diabetes and skin problems, predispose older patients to poor surgical outcomes.

Casting of the ankle, however, may have its own potential complications, including joint stiffness, decreased range of motion and improper healing.

Dr. Egol's research team studied 369 patients (313 patients younger than 60, and 56 patients ages 60 or older) who received surgical treatment of unstable ankle fractures, followed by six weeks of wearing a brace and not putting weight on their ankle. Total scores for functional outcome -- the ability to perform activities of daily living -- did not significantly differ between groups when measured at three, six and 12 months.

Function steadily improved over one year but to a lesser degree in the older patients, the study showed. This finding indicates elderly patients may need a more intensive rehabilitation program early on to improve functional ability, according to Dr. Egol.

Improved surgical techniques for ankle arthritis

When painful arthritis in the ankle does not respond to treatments such as medication, wearing a brace and physical therapy, surgery may become necessary. Ankle arthritis is characterized by cartilage loss around the ankle joint. Loss of cartilage usually occurs slowly over a period of years after injury. The standard surgical treatment is fusion, in which the surgeon eliminates the ankle joint and connects the bones with screws or other devices.

"Long-term results of ankle fusion are not always satisfactory in terms of function and pain relief, so doctors are looking for better ways of surgically treating arthritis of the ankle," said Charles Saltzman, MD, professor and chairman of orthopedics at the University of Utah, Salt Lake City. Dr. Saltzman is moderating a symposium on new surgical options for ankle arthritis at the Academy's Annual Meeting.

One emerging treatment is used when arthritis affects only part of the ankle, he said. It involves resurfacing a damaged area of ankle bone and cartilage -- which is the covering on the ends of bones -- and transplanting bone and cartilage from another part of the patient's body or from a donor. If the whole ankle has deteriorated, total ankle replacement with an artificial implant is an option for patients older than 60 or those limited by rheumatoid disease, according to Dr. Saltzman.

A surgery being investigated for treatment of severe ankle arthritis is distraction -- the surgical separation of two parts of bone -- and leaving a supportive frame on the ankle for three months. "Seventy percent of patients will have less pain three months after the frame is removed," Dr. Saltzman explained.

The type of surgical treatment a patient receives depends on the severity of the arthritis, the patient's age and how well aligned the ankle joint is.

Dr. Egol's research team received research or institutional support for their study from orthopaedic industry, including EBI, Zimmer and Stryker Howmedica.

An orthopaedic surgeon is a physician with extensive training in the diagnosis and non-surgical as well as surgical treatment of the musculoskeletal system, including bones, joints, ligaments, tendons, muscles and nerves.

With more than 29,000 members, the American Academy of Orthopaedic Surgeons ( http://www.aaos.org ) or ( http://www.orthoinfo.org ) is the premier not-for-profit organization that provides education programs for orthopaedic surgeons and allied health professionals, champions the interests of patients and advances the highest quality musculoskeletal health. Orthopaedic surgeons and the Academy are the authoritative sources of information for patients and the general public on musculoskeletal conditions, treatments and related issues. An advocate for improved patient care, the Academy is participating in the Bone and Joint Decade ( http://www.usbjd.org ) -- the global initiative in the years 2002-2011 - to raise awareness of musculoskeletal health, stimulate research and improve people's quality of life. The Academy's Annual Meeting is being held March 22-26, 2006 at McCormick Place in Chicago.

Source: American Academy of Orthopaedic Surgeons

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