Foot and Ankle Fractures in the Elderly: A Review on Osteoporosis, Biomechanics, and Rehabilitation

Fractures of the foot, ankle, and distal leg present unique biomechanical challenges, necessitating careful consideration during implant selection for effective management. In elderly patients, these injuries are further complicated by osteoporosis, poor bone quality, reduced soft tissue resilience, and slower rehabilitation, all of which contribute to higher complication risks and delayed recovery. These injuries disrupt normal load distribution and movement, requiring stabilization and functional restoration through various fixation methods, including screws, plates, intramedullary nails, and external fixators. Biomechanical factors such as weight-bearing capacity, implant flexibility, and alignment play critical roles in maintaining fracture stability and promoting healing. Comparative analyses of fixation techniques are essential to evaluate their respective strengths and limitations, emphasizing the balance between rigidity and adaptability. Postoperative protocols, including rehabilitation strategies and the biomechanics of implant removal, significantly influence patient outcomes. Advances in implant technology, such as bioresorbable materials, 3D printing, and computational modeling, offer promising improvements. These innovations, particularly for osteoporotic bone and anatomically complex regions, drive the development of personalized and functionally optimized solutions for fracture management.