Traumatic Lower Extremity Fractures in the Elderly

People ages 65 or greater will soon comprise a total of 1 in 5 US citizens. These will be people who are involved in motor vehicle accidents at a greater frequency. They will sustain greater injuries due to motor vehicle accidents when compared to young people and these injuries will lead to more disability than would be seen in youth.

Lower extremity fractures can be divided into ankle and foot fractures, which involve multiple bones, lower tibial and fibular fractures, which are also classified as “ankle” fractures. Midshaft tibial and fibular fractures are uncommon but when they occur, they are often considered “open” fractures, meaning that the bones break through the skin. This is because the bones are localized close to the outside skin than are other areas of bone.

Upper tibial fractures are more common than upper fibular fractures. Fractures of the tibial plateau are near the knee and can lead to knee arthritis even after the fracture has healed.

Lower extremity fractures are easily picked up by plain film x-ray but are sometimes missed if they are non-displaced. An MRI scan of the lower leg can pick up these kinds of fractures as well as stress fractures. Open fractures of the tibia are easily seen because of the opening in the skin and the likelihood of seeing exposed bone.

One study looked at the rate of lower extremity fractures in motor vehicle accidents and compared this rate with age. The examples looked at involved only front end collisions in people sitting in the front seat. The risk ratio was adjusted for driver vs. passenger, gender, and means of restraint, including seat belts and air bags. There was the first hint of an increased rate for people in their fourth decade of life which gradually increased to a statistically significant increase in the rate of fractures when people reached the seventh decade of life. These older people also suffered more disability from these types of injuries, resulting in wheelchair use, cane and walker use following the injury.

The treatment of tibial and fibular fractures varies with the displacement of the fracture and the area of the bone involved. Nondisplaced fibular fractures are often simply casted and the recovery nears 100 percent. In distal tibial fractures, surgical treatment or closed reduction is needed followed by casting and side effects later including arthritis of the ankle. Fractures of the tibia at any location usually require surgical treatment. Rods can be dropped between the upper and lower segments of the fracture so that the fracture is in good alignment. Plates and screws can also be used to put complex fractures together. The fractures are then casted with limited weight bearing and gradual recovery.

The prognosis of tibial and fibular fractures depends on the location, the degree of displacement and on the age of the individual. Older individuals heal more poorly than younger individuals and have prolonged disability as a result of the fracture(s) sustained in a motor vehicle accident.