Open Ankle Fractures in Older Individuals: A Multi-center Study.

The purpose of this study is to identify demographics, etiology, comorbidities, treatment, complications, and outcomes for older patients with open ankle fractures. Patients ≥60 years old who sustained an open ankle fracture between January 1, 2004 - March 31, 2014 at 6 Level 1 trauma centers were retrospectively reviewed. Univariate analysis using Chi-squared or Student's T-test was performed to identify associations between preoperative variables and two postoperative outcomes of interest: amputation and 1-year mortality. Multivariate analysis was performed using stepwise logistical regression to identify independent predictors of postoperative amputation and 1-year mortality. Of the 162 total patients, the most common mechanism of injury was a ground-level fall (51.9%). The most common fracture types were bimalleolar fractures (52.5%) followed by trimalleolar fractures (26.5%), with 41.5% of the fractures classified as Gustilo Anderson Classification Type 2 and 38.6% classified as Type 3A. The average number of surgeries required per patient was 2.1. Complications included: 15.4% superficial infection rate, 9.9% deep infection rate, and 9.3% amputation rate. The 1-year mortality rate was 13.6% and the overall mortality rate was 25.9%. Male gender and fracture type were found to be independent predictors for amputation after surgery (P = 0.009, 0.005, respectively). Older age and having diabetes were independent predictors for 1-year mortality after surgery (P = 0.021, 0.005 respectively). Overall, open ankle fractures in older individuals were associated with high rates of amputation and mortality.

Are low-energy open ankle fractures in the elderly the new geriatric hip fracture?

As the geriatric population in the United States continues to increase, ankle fractures in the elderly are predicted to exponentially increase in the future. As such, these injuries will become a common injury seen by physicians in various fields. Currently, no studies discussing low-energy open ankle fractures in the elderly and/or the mortality rate associated with these devastating injuries have been published. The purpose of the present study was to retrospectively review the morality rate associated with low-energy open ankle fractures in the elderly. We retrospectively identified 11 patients >60 years old who had sustained low-energy open ankle fractures and been treated at our institution. The patient demographics, mechanism of injury, wound size, medical comorbidities, treatment, follow-up data, and outcomes were recorded. Low-energy falls were defined as ground level falls from sitting or standing. The mean age of the patients was 70.72 years, with a mean body mass index of 35.93 ± 10.24. Of the 11 patients, 9 (81.81%) had ≥3 comorbidities (i.e., hypertension, diabetes, coronary artery disease, congestive heart failure, and/or chronic obstructive pulmonary disease). The mean size of the medially based ankle wound was 14.18 ± 4.12 cm; 10 (90.90%) were Gustilo and Anderson grade IIIA open ankle fractures. In our study, low-energy open ankle fractures in the elderly, very similar to hip fractures, were associated with a high mortality incidence (27.27%) at a mean of 2.67 ± 2.02 months, and 81.81% of our patients had ≥3 medical comorbidities.

Restoration of CAPAN-1 cells with functional BRCA2 provides insight into the DNA repair activity of individuals who are heterozygous for BRCA2 mutations.

Mutations in the BRCA2 gene are associated with inherited, early-onset breast cancer. CAPAN-1 cells have been useful for studying how BRCA2 mutations contribute to malignant transformation. They exhibit loss of heterozygosity (LOH), and the remaining copy of BRCA2 has a 6174delT mutation, which causes a premature C-terminal truncation that removes the domains for DNA repair and the nuclear localization signals. The DNA repair protein RAD51, which interacts with BRCA2, exhibits impaired nuclear translocation in CAPAN-1. It has been speculated that RAD51 may require BRCA2 for nuclear entry and that C-terminally truncated BRCA2 may retain RAD51 in the cytoplasm. This may cause heterozygous individuals to exhibit deficient DNA repair and cell viability comparable to individuals with LOH or biallelic BRCA2 mutations. We simulated a heterozygous condition by using stably transfected CAPAN-1 cells with wild-type BRCA2. Fusion of a nuclear localization signal to RAD51 did not increase its ability to independently enter the nuclei of CAPAN-1 cells. Furthermore, restoration of functional BRCA2 did not significantly improve DNA repair, nor did it reestablish cell viability in CAPAN-1 cells. The results imply that C-terminally truncated BRCA2 hinders RAD51 nuclear translocation, possibly contributing to genetic instabilities in homozygous as well as heterozygous individuals.