Outcomes of circular frame external fixation for tibia fracture in the elderly: comparison with a fracture-matched younger cohort.

INTRODUCTION: Circular frame fixation is a management method often used for complex fractures, or fractures with soft tissue compromise. Tibia fractures in older adults can be difficult to manage due to an association with osteoporosis, poor quality soft tissues, and a requirement for post-operative weight bearing to maintain function and independence. There is a paucity of evidence for the use of circular frames for tibia fractures in older adults. The available evidence suggests it is an effective treatment option, however, no study has compared treatment outcomes between older and younger patients.

AIM: To compare adverse events and outcomes between an 'older' cohort and 'younger' cohort of patients managed with circular frame for tibia fracture.

METHODS: The 'younger' cohort aged 18-50 and the 'older' cohort aged over 64 were identified from our institutional database. Injuries were classified using the AO/OTA and Gustilo-Anderson classifications. Data collection was retrospective and extracted from patient records. Adverse events were classified according to Paley as problems, obstacles or complications. Statistical analysis was performed, and significance set at p < 0.05.

RESULTS: 135 patients were included; 66 in the 'younger' cohort and 69 in the 'older' cohort. There were significantly more females in the 'older' cohort, with a higher proportion having systemic co-morbidity (85% vs 24%) and diabetes (25% vs 3%). There were more smokers in the 'younger' cohort (33% vs 12%). There was no significant difference in rate of or time to union. The 'younger' cohort was more likely to require further procedures to achieve union. More patients in the 'older' cohort suffered a problem (30% vs 3%); pin site infection accounted for all problems in the 'older' group, and half the problems in the 'younger' group. The rate of obstacles and complications was not different CONCLUSION: Circular frame fixation is a suitable management option for 'older' patients who sustain tibia fracture, as there is no difference between rate or time to union when compared to a 'younger' cohort. 'Older' patients are more likely to encounter pin site infection and should be counselled regarding this. There is no difference between rate of more significant obstacles or complication.