Quality of life and complications in elderly patients after pronation rotation type III ankle fractures treated with a cast and early weight-bearing.

BACKGROUND: Early weight-bearing is becoming increasingly common because it can positively affect the quality of life of patients. Therefore, the efficacy and safety of this conservative treatment should be assessed for different types of ankle fractures. The goal of this study was to compare early weight-bearing and non-weight-bearing in terms of effectiveness and safety in patients with pronation rotation type III ankle fractures treated nonsurgically. METHODS: A prospective multicenter cohort study was conducted over two years. Elderly patients with a nondisplaced pronation rotation type III ankle fracture were included. The main variables were the Barthel Index and SF-12 scores. The patients completed the questionnaires at six weeks, one year and two years. We also compared the complications associated with the two interventions. RESULTS: 30 patients were included in the weight-bearing group, while 32 patients were included in the non-weight-bearing (WB) group. The mean ages were 82.6 ± 2.6 years and 83.1 ± 2.6 years, respectively. Quality of life, measured with the SF-12 scale, increased significantly in both the short and long term in the WB group (53.5 ± 5.8 points vs 65.2 ± 4.4 points at 6 weeks and 70.1 ± 4.2 points vs. 80.9 ± 3.7 points at 2 years; p<0.001). The WB group also showed a higher quality of life, as measured by the Barthel Index (54.5 ± 5.2 points vs. 64.3 ± 4.0 points at 6 weeks and 71.0 ± 4.3 points vs. 80.7 ± 3.4 points at 2 years; p<0.001). CONCLUSIONS: Elderly patients with pronation rotation type III fractures could benefit from an early weight-bearing protocol in terms of quality of life and functionality.

Orthopedic treatment and early weight-bearing for bimalleolar ankle fractures in elderly patients: Quality of life and complications.

INTRODUCTION: Non-operative treatment of Weber's type B ankle fractures is essential in elderly patients. However, there is controversy in the post-reduction management of the fracture between the use of early weight-bearing or traditional treatment and non-weight-bearing for 6-8 weeks. There is limited evidence available regarding which rehabilitation regimen should be included. This study aimed to compare the quality of life and the number of complications between the two types of intervention (weight-bearing and non-weight-bearing). METHODS: Prospective cohort study. The quality of life was analyzed through the SF-12 and the Barthel Index at 6 weeks, one year and two years. The mean age was 83 ± 3 years in the weight-bearing group and 82 ± 3 in the non-weight-bearing group. In addition, the associated complications and costs were analyzed. RESULTS: A total of 70 patients were assigned in two groups: a control group of 37 patients (nonweight-bearing) and an experimental group of 33 patients (weight-bearing). A significant difference was observed in favor of early weight-bearing in SF-12 both, in the short and long terms (52.9 ± 5.3 vs 64.9 ± 4.6; p < 0.001 and 69.8 ± 4.1 vs 81.0 ± 3.6; p < 0.001). Significant differences were also observed in favor of early loading with respect to the Barthel Index (54.3 ± 4.9 vs 64.2 ± 3.9; p < 0.001 and 70.6 ± 4.2 vs 80.4 ± 3.0; p < 0.001). There were no significant differences in the complication rate between the two groups. CONCLUSION: Early weight-bearing improves the quality of life and functionality in elderly patients with Weber type B fracture without increasing complications.

Need to Prioritize Education of the Public Regarding Stroke Symptoms and Faster Activation of the 9-1-1 System: Findings from the Florida-Puerto Rico CReSD Stroke Registry.

Objective: Demographic differences (race/ethnicity/sex) in 9-1-1 emergency medical services (EMS) access and utilization have been reported for various time-dependent critical illnesses along with associated outcome disparities. However, data are lacking with respect to measuring the various components of time taken to reach definitive care facilities following the onset of acute stroke symptoms (i.e., stroke onset to 9-1-1 call, EMS response, time on-scene, transport interval) and particularly with respect to any differences across ethnicities and sex. Therefore, the specific aim of this study was to measure the various time intervals elapsing following the first symptom onset (FSO) from an acute stroke until stroke hospital arrival (SHA) and to delineate any race/ethnic/sex-related differences among any of those measurements. Methods: The Florida-Puerto Rico Stroke Registry (FLPRSR) is an on-going, voluntary stroke registry of hospitals participating in the Get with the Guidelines-Stroke initiative. The study population included patients treated at Florida hospitals participating in the FLPRSR between 2010 and 2014 who had called 9-1-1 and were managed and transported by EMS. In total, 10,481 patients (16% black, 8% Hispanic, 74% white) had complete data-sets that included birthdate/year, sex, ethnic background, date/hour/minute of FSO and date/hour/minute of EMS response, scene arrival, and SHA. Results: Median time from FSO to SHA was 339 minutes (interquartile range [IQR] of 284-442), 301 of which constituted the time elapsed from FSO to the 9-1-1 call (IQR =249-392) versus only 10 from 9-1-1 call to EMS arrival (IQR =7-14), 14 on-scene (IQR =11-18) and 12 for transport to SHA (IQR =8-19). The FSO to 9-1-1 call interval, being by far the longest interval, was longest among whites and blacks (302 minutes for both) versus 291 for Hispanics (p = 0.01). However, this 11-minute difference was not deemed clinically-significant. There were neither significant sex-related differences nor any racial/ethnic/sex differences in the relatively short EMS-related intervals. Conclusions: Following acute stroke onset, time elapsed for EMS response and transport is relatively short compared to the lengthy intervals elapsing between symptom onset and 9-1-1 system activation, regardless of demographics. Exploration of innovative strategies to improve public education regarding stroke symptoms and immediate 9-1-1 system activation are strongly recommended.