Mrs. Lucille McKenzie Scenario

Mrs. Lucille McKenzie Scenario



Mrs. Lucille McKenzie Scenario

Introduction

The management of ankle fractures in the elderly remains controversial and, in general, ankle fractures are treated by non-operative methods in this group of patients. However, some fractures are highly unstable and non-operative treatment can be difficult. Surgery in the elderly carries an increased risk due to pre-existing medical problems, osteoporosis-which may preclude stable fixation, and poor wound healing due to the quality of soft tissue around the ankle. High rates of post-operative complications have been reported in the elderly with infection in 12% of patients. Osteoporosis often precluded stable fixation with unsatisfactory results in 42% of patients. Thus, non-operative treatment has been recommended in patients over 50 years. In contrast, Nilsson have shown that open reduction and internal fixation (ORIF) in the elderly maintains better anatomical congruity and produces better outcome than non-operative treatment. Leach and Fordyce reported no fixation failures because of poor bone quality. In view of this controversy, we reviewed the early results and complications of ORIF of ankle fractures in patients over 70 years of age.

Discussion

Mrs Lucille McKenzie is a 72 year old lady. Three weeks ago Mrs Lucille McKenzie (72) was admitted to her local hospital after a fall that resulted in a broken ankle, severe bruising and a degree of disorientation. Her partner Sophia reported to the admissions team that Mrs Lucille McKenzie had tripped on the stairs. She also said that Mrs Lucille McKenzie had been quite forgetful for some time, and that more recently her moods had changed sometimes she would become quite angry and then almost childlike

On the ward, staff have found Mrs Lucille McKenzie quite passive and reluctant to ask for help even when needed assistance to get to the bathroom. Sometimes Mrs Lucille McKenzie asked if her mother would be visiting, and where exactly was she? Her mother had died 5 years earlier. Mrs Lucille McKenzie's ankle was plastered after her admission, and she gradually became more mobile sometimes walking to parts of the hospital where she was completely lost and unable to find her way back on her own ward. Sofia visited daily in the evenings and Mrs Lucille McKenzie always seemed pleased to see her, although some heated exchanges where observed. Mrs Lucille McKenzie explained to the sister that Sophia is under a lot of pressure at work, and is worried that she may lose her job. Sophia travels by train every day to work and with poor health from chronic chest condition due to heavy smoking, her absence at work has been commented on. Mrs Lucille McKenzie also said, during her initial assessment that she (Mrs Lucille McKenzie) had been working part-time in the cafe at a local garden centre, however they had been explaining to her that she probably should retire as she was often missing her shifts, and arriving on the wrong days.

History of Present Illness

Mrs Lucille McKenzie's primary medical diagnosis is dementia. Her ankle fracture may have been caused by changes in muscle ...