My 72-year-old father fell getting up off the couch and broke his ankle. No one wants to touch him to do surgery. They have put him in a splint for the moment and no weight-bearing or walking is allowed. What happens next?
Studies show that more and more older adults are being treated for ankle fractures. Not only are there more of these injuries, but they are more severe. In the past, osteoporosis (decreased bone density or "brittle bones") was blamed for most ankle fractures in adults 65 years old and older.
But new data suggests there are other more important risk factors. One of those risks is taking multiple medications called polypharmacy. Being overweight appears to be the most common risk factor. The heavier body mass increases the force on the soft tissue and bony structures when a fall happens. But diabetes, cigarette smoking, and inactivity may be the real underlying culprits.
A sedentary lifestyle leads to weakness and deconditioning resulting in decreased balance and increased risk of falls. People who have to push up with their arms to get out of a chair are more likely to suffer a fall and broken ankle. Your father's injury sounds suspiciously like it might fall into this risk category.
We point out all of these risk factors because dealing with the current damage and preventing future fractures is part of the conservative (nonsurgical) care. This approach is often taken for patients who have too many risks for surgery.
Medical problems such as high blood pressure, heart disease, diabetes, osteoporosis are just a few. Any of these (and especially a combination of two or more) can increase the risk for poor wound healing, high rates of infection, and malunion (fracture doesn't heal in an aligned position).
The potential for life-threatening blood clots, poor wound healing and/or infection may outweigh the benefits of the surgical procedure. The management approach chosen for your father may be "what's next" -- give the ankle a chance to heal followed by a rehab program.
A physical therapist will work with your father to restore joint motion, muscle strengthen, and proprioception (joint sense of position). All of these skills are needed for everyday activities and to prevent future ankle sprains or other injuries.
He may use a kneeling walker or scooter now but eventually he will be able to progress to partial and then full weight-bearing. The cast may be replaced with a protective book (depending on surgeon preference). Don't expect a quick return to full function. This process can take weeks to months.
Eric J. Strauss, MD, and Kenneth A. Egol, MD. Identifying and Managing Ankle Fractures in Older Patients. In The Journal of Musculoskeletal Medicine. April 2011. Vol. 28. No. 4. Pp. 137-147.
*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.