Gustilo-Anderson type III tibial fractures have poor functional outcomes in patients over 75 years

Background: Previous outcome studies in open tibial fractures have commonly assessed young patients and there is a paucity of data regarding outcomes in the elderly. The aim of this study is to assess functional outcomes for patients over 75 years with Gustilo-Anderson Grade III open tibial fractures, including mobility and residential status.

Methods: Outcomes for all patients over 75 years admitted with grade III open tibial fractures to a UK level 1 trauma centre during a 5-year period (January 2010-May 2015) were analysed. Long-term follow up of surviving patients (median 44 months post injury) was undertaken in February 2016.

Results: Twenty-nine patients (24 female, 5 male - median 85 years) were included. Prior to injury 48% (n = 14) patients were independently mobile and 45% (n = 13) were living at home without care. Two-thirds of injuries were low energy; all patients sustained a grade III open tibial fracture. The 12-month mortality rate was 28% (n = 8) and mortality at long-term follow-up 48% (n = 14). From pre-injury to long-term 8% (n = 1) patients did not change mobility status, 75% (n = 9) reduced by one grade (e.g. independent to walking aid) and 16% (n = 2) by two grades. Fifty eight percent (n = 7) of patients retained residential status, 17% (n = 2) reduced by one grade and 25% (n = 3) by two grades.

Conclusion: Grade III open tibial fractures are a significant injury in the elderly associated with poor outcomes with respect to return to mobility and pre-injury residential status. Our results suggest that a greater emphasis on intensive rehabilitation should be considered in this patient group.