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Perioperative outcomes following open vs closed geriatric ankle fractures: A large, propensity-matched cohort study
Logan M Good1, Alexander N Berk1, Cyrus Eghtedari2
1University Hospitals Cleveland Medical Center, Department of Orthopaedic Surgery, 11100 Euclid Ave, Cleveland, OH 44106, USA; The MetroHealth System, Department of Orthopaedics, 2500 Metrohealth Dr, Cleveland, OH 44109, USA; Case Western Reserve University School of Medicine, 9501 Euclid Ave, Cleveland, OH 44106, USA.
Objectives:
Open ankle fractures in the geriatric population display poor outcomes. However, limited data exists comparing operative outcomes between open and closed geriatric ankle fractures. Our purpose was to investigate differences in perioperative complications and mortality among open and closed ankle fractures in geriatric patients.
Methods:
The TriNetX US Collaborative Network database was queried to identify patients aged 65 and older who experienced operatively treated, isolated open or closed ankle fractures between 2014 and 2024. Patients were divided into two propensity-matched cohorts depending on open vs closed injuries. Rates of complications and mortality were compared between operatively treated open and closed ankle fractures in geriatric patients.
Results:
Overall, 27,860 patients met inclusion criteria. Of these, 25,257 (90.7 %) sustained closed ankle fractures and 2603 (9.3 %) sustained open ankle fractures. After 1:1 propensity matching, each cohort included 2565 patients. At early time points (<30 days), DVT, MI, sepsis, pneumonia, AKI, ABLA, opioid use, deep infection, ED visits and rehospitalizations were higher in open ankle fractures (p < 0.05). At delayed time points from 90 days to 1 year, DVT, pneumonia, ARDS, AKI, ABLA, SSI, deep infection, sepsis, BKA, emergency department visits, rehospitalizations and death remained significantly higher in open ankle fractures (p < 0.05). Notably, open ankle fractures had significantly increased rates of mortality at 90 days (p = 0.007), 180 days (p = 0.004), and 1 year (p < 0.0001). At 1 year, bimalleolar and trimalleolar open ankle fractures also demonstrated significantly higher mortality rates (p < 0.05).
Conclusions:
Open geriatric ankle fractures, irrespective of fracture morphology, demonstrate significantly higher rates of mortality and postoperative complications including DVT, MI, pneumonia, AKI, sepsis, SSI, deep infections, BKA, emergency department visits and rehospitalizations. Our findings suggest the need for enhanced perioperative counseling and preventative strategies to address modifiable risk factors in geriatric orthopaedic patients undergoing operative fixation for open ankle fractures.
Level Of Evidence:
retrospective cohort study, level of evidence III.
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