Abstract
Background
Ankle fractures are common orthopedic injuries with complication rates fixation of up to 40%. Limited evidence exists in the literature regarding complications in the elderly population, and moreover, these studies frequently define elderly arbitrarily at 60–65 years old. The purpose of the present study was to utilize a large, validated database to evaluate whether there is an inflection point of age when postoperative complications after an ankle fracture significantly increase.
Methods
A retrospective review of all patients in the American College of Surgeons National Surgical Quality Improvement Program database who underwent fixation of an ankle fracture between 2012 and 2018 was performed. Patients were identified within the database using the Current Procedural Terminology codes. Appropriate statistical analysis was performed with p value less than 0.05 considered statistically significant.
Results
A total of 27,633 fractures were including and comprised of 221 posterior malleolar, 1567 medial malleolar, 8495 lateral malleolar, 10,175 bimalleolar, and 7175 trimalleolar. A total of 1545 complications were encountered (5.6%). There was a statistically significant association between increasing age and complications (OR = 1.03; p < 0.001). Further analysis shows the largest spike in complications within the age 78 + bracket. There were no overall interaction effects between age and fracture subtype (p = 0.223).
Conclusion
ORIF of ankle fractures is a common orthopedic procedure performed on patients of all ages, with complications ranging in severity. In order to best counsel patients on their individual postoperative risks, large datasets are often necessary to prognosticate. This study found that postoperative complications increase with advanced age. The incidence of complications did not spike for patients around the age of 65, but rather followed an incremental linear pattern with the largest increase in odds ratio occurring at age 78 and above. Complication rate was not associated with specific fracture type based off of ICD codes.
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References
Elsoe R, Ostgaard SE, Larsen P (2018) Population-based epidemiology of 9767 ankle fractures. Foot Ankle Surg 24(1):34–39
Donken CC, Al-Khateeb H, Verhofstad MH, van Laarhoven CJ (2012) Surgical versus conservative interventions for treating ankle fractures in adults. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD008470.pub2
Mehta SS, Rees K, Cutler L, Mangwani J (2014) Understanding risks and complications in the management of ankle fractures. Indian J Orthop 48(5):445–452
Kannus P, Palvanen M, Niemi S, Parkkari J, Järvinen M (2002) Increasing number and incidence of low-trauma ankle fractures in elderly people: Finnish statistics during 1970–2000 and projections for the future. Bone 31(3):430–433
Ebraheim NA, Mekhail AO, Gargasz SS (1997) Ankle fractures involving the fibula proximal to the distal tibiofibular syndesmosis. Foot Ankle Int 18(8):513–521
Macera A, Carulli C, Sirleo L, Innocenti M (2018) Postoperative complications and reoperation rates following open reduction and internal fixation of ankle fracture. Joints 6(2):110–115
SooHoo NF, Krenek L, Eagan MJ, Gurbani B, Ko CY, Zingmond DS (2009) Complication rates following open reduction and internal fixation of ankle fractures. J Bone Joint Surg Am 91(5):1042–1049
Stavem K, Naumann MG, Sigurdsen U, Utvåg SE (2017) The association of body mass index with complications and functional outcomes after surgery for closed ankle fractures. Bone Joint J 99(10):1389–1398
Chaudhary SB, Liporace FA, Gandhi A, Donley BG, Pinzur MS, Lin SS (2008) Complications of ankle fracture in patients with diabetes. J Am Acad Orthop Surg 16(3):159–170
Testa G, Ganci M, Amico M et al (2019) Negative prognostic factors in surgical treatment for trimalleolar fractures. Eur J Orthop Surg Traumatol 29(6):1325–1330
Malik AT, Quatman CE, Phieffer LS, Ly TV, Wiseman J, Khan SN (2019) The impact of metabolic syndrome on 30-day outcomes in geriatric hip fracture surgeries. Eur J Orthop Surg Traumatol 29(2):427–433
Bozzio AE, Gala RJ, Villasenor MA, Hao J, Mauffrey C (2014) Orthopedic trauma surgery in the morbidly obese patient. Eur J Orthop Surg Traumatol 24(4):421–425
Koval KJ, Zhou W, Sparks MJ, Cantu RV, Hecht P, Lurie J (2007) Complications after ankle fracture in elderly patients. Foot Ankle Int 28(12):1249–1255
Anderson SA, Li X, Franklin P, Wixted JJ (2008) Ankle fractures in the elderly: initial and long-term outcomes. Foot Ankle Int 29(12):1184–1188
Ali MS, McLaren CA, Rouholamin E, O’Connor BT (1987) Ankle fractures in the elderly: nonoperative or operative treatment. J Orthop Trauma 1(4):275–280
Anand N, Klenerman L (1993) Ankle fractures in the elderly: MUA versus ORIF. Injury 24(2):116–120
Buckingham RA, Hepple S, Winson IG (2000) Outcome of ankle fractures in the elderly. Foot Ankle Surg 6(3):175–178
Davidovitch RI, Walsh M, Spitzer A, Egol KA (2009) Functional outcome after operatively treated ankle fractures in the elderly. Foot Ankle Int 30(8):728–733
Zaghloul A, Haddad B, Barksfield R, Davis B (2014) Early complications of surgery in operative treatment of ankle fractures in those over 60: a review of 186 cases. Injury 45(4):780–783
Salai M, Dudkiewicz I, Novikov I, Amit Y, Chechick A (2000) The epidemic of ankle fractures in the elderly–is surgical treatment warranted? Arch Orthop Trauma Surg 120(9):511–513
Pley C, Purohit K, Krkovic M, Abdulkarim A (2020) A health economic analysis of the management of open lower limb fractures in the elderly. Eur J Orthop Surg Traumatol 30(8):1383–1391
Kadakia RJ, Ahearn BM, Schwartz AM, Tenenbaum S, Bariteau JT (2017) Ankle fractures in the elderly: risks and management challenges. Orthop Res Rev 9:45–50
Lynde MJ, Sautter T, Hamilton GA, Schuberth JM (2012) Complications after open reduction and internal fixation of ankle fractures in the elderly. Foot Ankle Surg 18(2):103–107
Strauss EJ, Egol KA (2007) The management of ankle fractures in the elderly. Injury 38(Suppl 3):S2-9
Rammelt S (2017) Management of ankle fractures in the elderly. EFORT Open Rev 1(5):239–246
Leyes M, Torres R, Guillén P (2003) Complications of open reduction and internal fixation of ankle fractures. Foot Ankle Clin 8(1):131–147
Hoiness P, Stromsoe K (1999) Early complications of surgically managed ankle fractures related to the AO classification. A review of 118 ankle fractures treated with open reduction and internal fixation. Arch Orthop Trauma Surg 119(5–6):276–279
Sun Y, Wang H, Tang Y et al (2018) Incidence and risk factors for surgical site infection after open reduction and internal fixation of ankle fracture: a retrospective multicenter study. Medicine 97(7):e9901–e9901
Ovaska MT, Mäkinen TJ, Madanat R et al (2013) Risk factors for deep surgical site infection following operative treatment of ankle fractures. J Bone Joint Surg Am 95(4):348–353
Wukich DK, Crim BE, Frykberg RG, Rosario BL (2014) Neuropathy and poorly controlled diabetes increase the rate of surgical site infection after foot and ankle surgery. J Bone Joint Surg Am 96(10):832–839
Loder RT (1988) The influence of diabetes mellitus on the healing of closed fractures. Clin Orthop Relat Res 232:210–216
Cavo MJ, Fox JP, Markert R, Laughlin RT (2015) association between diabetes, obesity, and short-term outcomes among patients surgically treated for ankle fracture. J Bone Joint Surg Am 97(12):987–994
Ganesh SP, Pietrobon R, Cecílio WA, Pan D, Lightdale N, Nunley JA (2005) The impact of diabetes on patient outcomes after ankle fracture. J Bone Joint Surg Am 87(8):1712–1718
Theadom A, Cropley M (2006) Effects of preoperative smoking cessation on the incidence and risk of intraoperative and postoperative complications in adult smokers: a systematic review. Tob Control 15(5):352–358
Wang J, Chen K, Li X et al (2019) Postoperative adverse events in patients with diabetes undergoing orthopedic and general surgery. Medicine 98(14):e15089–e15089
Saithna A, Moody W, Jenkinson E, Almazedi B, Sargeant I (2009) The influence of timing of surgery on soft tissue complications in closed ankle fractures. Eur J Orthop Surg Traumatol 19(7):481–484
Schoenfeld AJ, Tipirneni R, Nelson JH, Carpenter JE, Iwashyna TJ (2014) The influence of race and ethnicity on complications and mortality after orthopedic surgery: a systematic review of the literature. Med Care 52(9):842–851
Zhang W, Lyman S, Boutin-Foster C et al (2016) Racial and ethnic disparities in utilization rate, hospital volume, and perioperative outcomes after total knee arthroplasty. J Bone Joint Surg Am 98(15):1243–1252
Brooks Carthon JM, Jarrín O, Sloane D, Kutney-Lee A (2013) Variations in postoperative complications according to race, ethnicity, and sex in older adults. J Am Geriatr Soc 61(9):1499–1507
Kothari P, Lee NJ, Leven DM et al (2016) Impact of gender on 30-day complications after adult spinal deformity surgery. Spine 41(14):1133–1138
Al-Taki M, Sukkarieh HG, Hoballah JJ et al (2018) Effect of gender on postoperative morbidity and mortality outcomes: a retrospective cohort Study. Am Surg 84(3):377–386
Gu A, Wei C, Bernstein SA et al (2020) The impact of gender on postoperative complications after revision total knee arthroplasty. J Knee Surg 33(4):387–393
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Danilkowicz, R.M., Grimm, N.L., Kim, J. et al. Increasing age and modifiable comorbidities are associated with short-term complications after open reduction and internal fixation of ankle fractures. Eur J Orthop Surg Traumatol 32, 113–119 (2022). https://doi.org/10.1007/s00590-021-02927-z
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DOI: https://doi.org/10.1007/s00590-021-02927-z