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High-risk ankle fractures in high-risk older patients: to fix or nail?

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Optimal treatment of high-risk ankle fractures in older, comorbid patients is unknown. Results of open reduction internal fixation (ORIF) versus tibiotalocalcaneal (TTC) fusion nailing for the treatment of high-risk geriatric ankle fractures were investigated.

Materials and methods

Results of ORIF versus TTC fusion nailing were evaluated via retrospective case–control cohort study of 60 patients over age 50 with an open ankle fracture or one with at least 50% talar subluxation and at least 1 high-risk comorbidity: diabetes mellitus (DM), peripheral vascular disease, immunosuppression, active smoking, or a BMI > 35. The primary outcome was reoperation rate within 1-year post-surgery. Secondary outcomes include infection, peri-implant fracture, malunion/nonunion, mortality, length of stay, disposition, and hospital acquired complications.

Results

Mean age was 71 (ORIF) and 68 (TTC). 12/47 (25.5%) ORIF cases were open fractures versus 4/14 (28.6%) with TTC. There were no significant differences between ORIF and TTC in 1-year reoperation rates (17% vs 21.4%), infection rates (12.8% vs 14.3%), or union rates (76.% vs 85.7%), respectively. One TTC patient sustained a peri-implant fracture treated nonoperatively. There were no significant differences in medical risk factors between groups other than a higher rate of DM in the TTC group, 42.6% vs 78.6%, p = 0.02. Incomplete functional outcome data in this challenging patient cohort precluded drawing conclusions.

Conclusion

ORIF and TTC fusion nailing result in comparable and acceptable reoperation, infection, and union rates in treating high-risk ankle fractures in patients over 50 with at least 1 major comorbidity for increased complications; further study is warranted.

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Funding

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Emory University, Grady Memorial Hospital, 80 Jesse Hill Jr Dr SE, Atlanta, GA, 30303, USA

    Thomas M. Large

  2. Orthopaedic Trauma Services, Mission Hospital, Asheville, NC, USA

    Adam M. Kaufman & Harold M. Frisch

  3. Empiric Health (Olive), Asheville, NC, USA

    Kaitlyn R. Bankieris

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Contributions

All authors contributed to the study conception and design. Material preparation and data collection were performed by TML, AMK, and HMF and analysis was performed by KRB. The first draft of the manuscript was written by TML and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Thomas M. Large.

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Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Institutional Review Board at Mission Hospital, Asheville, NC, USA: IRB Net #1139182-5, IRB Protocol #: 17-10-1745, NF. Data were analyzed and kept in a deidentified local network secured repository and is not publicly available.

Informed consent

Informed consent was obtained from all individual participants included in the study. The authors affirm that human research participants provided informed consent for publication of the deidentified images in Figs. 1, 2, 3, 4 and 5.

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Large, T.M., Kaufman, A.M., Frisch, H.M. et al. High-risk ankle fractures in high-risk older patients: to fix or nail?. Arch Orthop Trauma Surg 143, 3725–3734 (2023). https://doi.org/10.1007/s00402-022-04574-3

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  • DOI: https://doi.org/10.1007/s00402-022-04574-3

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