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

摘要

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.