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. 2023 Jul;143(7):3725-3734.
doi: 10.1007/s00402-022-04574-3. Epub 2022 Aug 10.

High-risk ankle fractures in high-risk older patients: to fix or nail?

Thomas M Large  1 , Adam M Kaufman  2 , Harold M Frisch  2 , Kaitlyn R Bankieris  3
Affiliations

High-risk ankle fractures in high-risk older patients: to fix or nail?

Thomas M Large et al. Arch Orthop Trauma Surg. 2023 Jul.

Abstract

Introduction: Optimal treatment of high-risk ankle fractures in older, comorbid patients is unknown. Results of open reduction internal fixation (ORIF) versus tibiotalocalcaneal (TTC) fusion nailing for the treatment of high-risk geriatric ankle fractures were investigated.

Materials and methods: Results of ORIF versus TTC fusion nailing were evaluated via retrospective case-control cohort study of 60 patients over age 50 with an open ankle fracture or one with at least 50% talar subluxation and at least 1 high-risk comorbidity: diabetes mellitus (DM), peripheral vascular disease, immunosuppression, active smoking, or a BMI > 35. The primary outcome was reoperation rate within 1-year post-surgery. Secondary outcomes include infection, peri-implant fracture, malunion/nonunion, mortality, length of stay, disposition, and hospital acquired complications.

Results: Mean age was 71 (ORIF) and 68 (TTC). 12/47 (25.5%) ORIF cases were open fractures versus 4/14 (28.6%) with TTC. There were no significant differences between ORIF and TTC in 1-year reoperation rates (17% vs 21.4%), infection rates (12.8% vs 14.3%), or union rates (76.% vs 85.7%), respectively. One TTC patient sustained a peri-implant fracture treated nonoperatively. There were no significant differences in medical risk factors between groups other than a higher rate of DM in the TTC group, 42.6% vs 78.6%, p = 0.02. Incomplete functional outcome data in this challenging patient cohort precluded drawing conclusions.

Conclusion: ORIF and TTC fusion nailing result in comparable and acceptable reoperation, infection, and union rates in treating high-risk ankle fractures in patients over 50 with at least 1 major comorbidity for increased complications; further study is warranted.

Keywords: Ankle ORIF; Ankle fracture; Geriatric; Osteosynthesis; TTC nailing.

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