Rate of and Risk Factors for Intermediate-Term Reoperation After Ankle Fracture Fixation: A Population-Based Cohort Study

Abstract

Objective: Establish baseline rates of and risk factors for reoperation within 1 or 2 years of ankle open reduction internal fixation (ORIF).

Design: Retrospective, population-based cohort study.

Setting: Two hundred two hospitals in Ontario, Canada (approximate population 13.6 million in 2014).

Patients/participants: Forty five thousand four hundred forty-four patients who underwent ankle ORIF performed by 710 different surgeons between January 1, 1994, and December 31, 2011.

Main outcome measurements: Intermediate-term reoperation because of isolated implant removal, repeat ORIF, irrigation and debridement (I&D) for infection, or amputation. Multivariable logistic regression related potential prognostic factors (patient, provider, and injury) to reoperation.

Results: There were 8906 patients who underwent at least one subsequent operation (19.6%). The most common procedure was isolated implant removal (18.1%); odds of removal being higher for females [odds ratio (OR), 1.53; 95% confidence interval (CI), 1.45-1.62; P < 0.001]. N = 674 patients (1.5%) underwent reoperation for another reason. The odds of repeat ORIF and I&D infection were greater for open fractures (OR 2.17; 95% CI, 1.22-3.86; P = 0.008 and OR 3.12; 95% CI, 1.94-5.03; P < 0.001). Odds of amputation was highest for diabetics (OR 7.42; 95% CI, 3.73-14.86; P < 0.001).

Conclusions: Isolated implant removal accounts for the vast majority of intermediate-term reoperations after ankle ORIF. Reoperation for other reasons (repeat ORIF, I&D, or amputation) was extremely rare, even among the highest risk patients. Concerns regarding reoperation for these reasons should not preclude operative treatment in any patient, provider, or injury group we considered.

Level of evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.