OBJECTIVE

To evaluate the efficacy of a rehabilitation programme including balance task-specific training in improving physical function, pain, activities of daily living (ADL), balance and quality of life in subjects after a hip fracture.

DESIGN

Randomized controlled trial.

SUBJECTS

A total of 52 older subjects selected for internal fixation due to extra-capsular hip fracture were randomized to be included in an experimental ( n = 26) and control group ( n = 26).

INTERVENTIONS

The experimental group underwent a rehabilitation programme based on balance task-specific training. The control group underwent general physiotherapy, including open kinetic chain exercises and walking training. Both groups individually followed programmes of 90-minute sessions five times/week for three weeks.

OUTCOME MEASURES

The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), a Pain Numerical Rating Scale, the Berg Balance Scale, the Functional Independence Measure and the 36-item Short-Form Health Survey. The participants were evaluated before and after training, and after 12 months.

RESULTS

Significant effects of time, group and time × group were found for all outcome measures in favour of the experimental group. A clinically important between-group difference of 25 points was achieved after training and at follow-up in terms of the primary outcome (WOMAC function before treatment, after treatment and at follow-up was 84.8 (3.7), 39.8 (4.9) and 35.7 (6.2) for the experimental group and 80.9 (5.7), 65.2 (7.1) and 61.0 (11.1) for the control group).

CONCLUSION

An inpatient rehabilitation programme based on balance task-specific training is useful in improving physical function, pain, ADL and quality of life in older patients after hip fracture.

Frailty fractures encompass pelvic ring fractures in the elderly--a condition more frequently encountered in women, usually with pre-existing osteoporosis. The incidence of these fractures is increasing, following the increase in average life expectancy. Most of the times, they are the result of a minor injury, of which the patient has little or no recollection; the clinical signs and symptoms, radiological changes and the degree of fracture stability vary greatly. As such, there is a wide range of therapeutic options and one of the most important decisions for the physician is choosing between surgery and conservative treatment. We present the case of an elderly female patient with multiple pelvic ring fractures, and a medical history of cardiovascular disease and osteoporosis; the orthopedic examination recommended conservative treatment which was carried out in the Geriatric Clinic of the "Dr. C.I. Parhon" Hospital. Following the complete physical examination and through geriatric evaluation, a complex therapeutic plan was devised, which included: recovery through physiotherapy, adequate nutrition, psychological support, treatment of the cardiovascular comorbidities and prevention of the consequences of extended bed rest. The treatment lasted for 60 days and the outcome was favorable: decreased bone frailty, mainly through preserving muscle tone and osteoarticular function, correction of malnutrition, improvement of depression and partial recovery of patient's mobility; the results of our therapy made it possible for the patient to return home, where she leaves alone. She will need help with daily household chores, but she intends to continue the recovery therapy as means of increasing her quality of life and independence.

INTRODUCTION

Tibial pilon fractures present a complex challenge, particularly in geriatric patients with comorbidities and compromised soft tissue. Traditional treatment options such as open reduction and internal fixation (ORIF) and tibiotalocalcaneal (TTC) nailing have shown variable outcomes, often complicated by infection, nonunion, and malunion. Tibiotalar nailing is an alternative approach that preserves subtalar joint motion while providing stable fixation, though, there is limited literature on its efficacy in geriatric pilon fractures. This report describes a case of a 64-year-old female with multiple comorbidities presenting with tibial pilon fracture successfully managed with antegrade tibiotalar intramedullary nailing, highlighting the potential advantages of this technique.

CASE REPORT

A 64-year-old female with a history of chronic obstructive pulmonary disease, hypertension, and a significant smoking history presented with a right tibial pilon and distal fibula fracture following a fall down the stairs. Due to her medical comorbidities and poor soft tissue envelope, she was at high risk for complications with ORIF. After discussing multiple treatment options, she elected to proceed with a tibiotalar intramedullary nail to optimize function while minimizing surgical morbidity. The procedure was performed using a suprapatellar approach, and an 8mm nail was inserted to preserve bone stock and future surgical options. Postoperatively, she progressed well, achieving full fracture healing by 9 months with minimal pain and functional independence. She declined further surgical intervention for hardware removal or ankle fusion, reporting satisfaction with her outcome.

CONCLUSION

This case highlights the successful use of tibiotalar nailing as a viable alternative to ORIF and TTC nailing for managing geriatric pilon fractures with significant comorbidities. By preserving subtalar joint function, this approach offers potential advantages in mobility and quality of life while mitigating the risks associated with more invasive procedures. Given the limited existing literature on this technique, this report contributes to the growing body of evidence supporting its use. Further studies are warranted to compare tibiotalar nailing with conventional approaches in larger cohorts to refine its indications and optimize patient outcomes.

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