Analysis of risk factors of the postoperative complications of surgical treatment of ankle fractures in the elderly: A series of 477 patients - 09/05/16

Doi : 10.1016/j.otsr.2016.03.004

Y. Varenne ^a,^⁎ , J. Curado ^b, Y. Asloum ^c, E. Salle de Chou ^b, F. Colin ^a, F. Gouin ^a
^a Clinique Chirurgicale de Chirurgie Orthopédique et Traumatologique, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France
^b Service d’Orthopédie–Traumatologie, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France
^c Service d’Orthopédie–Traumatologie, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France

^⁎Corresponding author.

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Abstract

Introduction

The surgical strategy of ankle fractures in elderly subjects is controversial because of the high rate of local and general complications. The goal of this study was to identify the risk factors of complications of ankle fractures in elderly subjects.

Materials and methods

Four hundred and seventy-seven patients operated between 2008 and 2014 were included in this retrospective study. The minimum age was 60 years old for women and 70 for men. Patients presenting with a pilon fracture or with less than 3 months of follow up were excluded. A clinical evaluation of autonomy based on the Parker score and a radiographic assessment were performed preoperatively and during follow up The characteristics of the fracture, comorbidities and the type of internal fixation used were reported.

Results

This series included 384 women (81%), mean age 74 years old (60–99). Most fractures were Weber type B (n=336). Four hundred and thirty-one patients (90.4%) received so-called standard internal fixation and 46 patients (9.6%) received so-called atypical fixation. The rate of general complications was 4.6%, and local complications was 23.9%. Univariate analysis of the risk factors of general complications identified 2 significant criteria: age older than 80 (OR=3.46, P=0.012) and more than 2 comorbidities 2 (OR=10.6, P<0.0001). Univariate analysis of risk factors of local complications identified 2 criteria: an open fracture (OR=4.90, P=0.0016) and age over 80 (OR=1.85, P=0.024). Multivariate analysis of risk factors of local complications confirmed the relationship with open fractures (OR=4.67, P<0.001).

Discussion

The results of the management of ankle fractures in elderly subjects is satisfactory. The use of standard internal fixation techniques is recommended. The risk of complications increases with age, the severity of the fracture and the number of associated diseases.