IOA 2022

Comparing Mortality among Elderly Patients with Surgically Treated Open vs Closed Ankle Fractures

Haggai Schermann 1,2 Takahisa Ogawa 2,3 Bart Lubberts 2 Gregory Waryasz 2 Philip Kaiser 2 Christopher William DiGiovanni 2 Daniel Guss 2
1Division of Orthopedics, Tel Aviv Sourasky Medical Center, Israel
2Foot and Ankle Service, Massachusetts General Hospital, USA
3Orthopedic Surgery, Tokyo Medical and Dental University Medical Center, Japan

Introduction:
Previous studies have demonstrated high mortality rates associated with open ankle fractures in elderly patients, as high as 23-27% during the first year postoperatively. The purpose of this study was, 1) to investigate the association of patient age and comorbidities with open versus closed ankle fractures and, 2) to quantify the risk of mortality associated with open ankle fractures in the elderly population.

Methods:
This is a retrospective cohort study of 1,045 patients aged 65 years and older, with ankle fractures undergoing surgical fixation between 2010 and 2020 at three medical centers (Levels 1-2). Collected data included patient demographics, age, gender, language, race, comorbidities, and open vs. closed fracture. A case-control approach and logistic regression analysis were used to identify risk factors for open fractures. Propensity score matching and survival analysis were used to measure the hazard of mortality attributable to open vs. closed ankle fractures.

Results:
There were 128 (12.2%) patients with open ankle fractures in this cohort. Patients with open ankle fractures were more likely to be older, to be active smokers (OR=1.7, p=0.049), and tended to have a higher number of medical comorbidities including: hypertension (OR=2, p=0.006), chronic kidney disease (OR=2.9, p=0.005). Open ankle fractures were, independent of comorbid conditions, associated with higher risk of mortality (HR=1.7, p=0.03).

Discussion:
While patients with open ankle fractures are older and have more comorbidities than patients with closed ankle fractures, there is an independent association between open ankle injury and mortality. Elderly with open ankle fractures face mortality at a 70% higher rate than elderly with closed ankle fractures. In a circular manner, comorbid conditions may also raise the likelihood of a given patient’s fracture being open. These findings may help in counseling patients and their families who present with what has hitherto been an underappreciated life-threatening condition.