Scripties UMCG - Rijksuniversiteit Groningen
 
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Teendrukmeting als betrouwbare meting voor vaatstatus in onderbeenfracturen bij ouderen

(2018) Cort, B. de (Boris)

Introduction: Fractures of the ankle, tibial plafond and tibial shaft are fractures that
are associated with a high prevalence of postoperative complications. At older age the chance
of these complications increases, as there are more co-morbidities. Several studies have
shown that in addition to diabetes, smoking and male sex, the occurrence of peripheral arterial
occlusive disease (PAOD) is an important risk factor for these complications. Complications
not only affect fracture healing, but also quality of life and, in the worst case, lead to
amputation of the extremity or death. This study focuses on the screening for PAOD /
vascular status and the identification thereof as a risk factor for complications.
Material and methods: Retrospectively, patients aged 60 or older whom presented
themselves with fractures of the tibial plafond and tibial shaft in the period 2010-2017 were
included. Possible risk factors and demographic characteristics were noted. In addition, a
prospective study was conducted including all patients aged 60 or older who presented with a
fracture of the ankle, tibial plafond or tibial shaft. The same parameters and characteristics
were noted. Also in the prospective group a toe-pressure measurement and blood pressure
measurement was performed of both the affected and the healthy extremity. An age-equal
control group of patients with a distal radius fracture was formed.
Results: In the retrospective group, 86 patients were included and in 30.7% of the
cases there was a complication. After multivariate analysis of the risk factors, only male
gender appeared to be a significant risk factor for complications. Prospectively, 16 patients
were included and 29 in the control group. Vascular status was determined by means of toepressure
measurement and toe/brachial index (TBI) derived therefrom. Both groups were
found to have a comparable toe pressure and TBI. After further analysis, a reduced toe
pressure did not appear to correlate significantly with the risk of complications.
Conclusion: toe-pressure can be used as a measurement for vascular status in elderly
patients with fractures of the lower leg. In order to link the reduced toe pressure to increased
complication risk, however, more research is required and the study cohort needs to be
enlarged.






 
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