The Outcome of Operative Ankle Fracture Fixation in the Eldelry

Background: Ankle fractures are among the most common in all age groups. Unstable ankle fractures require open reduction, internal fixation surgery (ORIF). Although the results of these procedures are predictable, little is known of the outcome of geriatric patient undergoing ORIF. The purpose of this study was to assess the outcome of patients over 60 years undergoing ORIF of unstable ankle fractures.

Patients and methods: this retrospective study included 74 patients over 60 years of age who underwent operative fixation of unstable ankle fractures between 2009 to 2015 and were available for follow-up of at least one year. Patient data included risk factors for failure (diabetes, smoking, renal disease etc). Outcome included reoperation, and surgical complications. The pinjury radiographs were assessed for AO/OTA classification. The latest postoperative radiographs were analyzed for Lateral Clear Space (LTS), Medial clear space (MCS), talar tilt and talocrural angle.

Results: 70% of fractures were AO 44B. Overall complication rate was 54% and included infection (9.5%), delayed wound healing (9.5%), tibiofibular synostosis(14.9%) and traumatic arthritis (12.2%). The only factors that were significantly correlated with complications included age and initial pathologic LCS, repeatability of measurement was acceptable (ICC Kappa ceffecient 0.7)

Conclusion: Operative ankle fractures in the elderly results in higher complication rates both clinically and radiographically than expected. The fact the LCS was associated with higher complication rates and the high degree of tibiofibular synostosis may indicate a high rate of undiagnosed syndesmotic injuries in these group of patients.