Related Experiment Video
Updated: May 28, 2026
Identifying Frailty Using Point-of-Care Ultrasonography: Image Acquisition and Assessment
Published on: July 26, 2024
A Proposed Preoperative Risk Score for Predicting Surgical Site Complications After Ankle Fracture Fixation in Frail
Tyler K Williamson1, Luke Verlinsky, Casey McDonald
1From the Department of Orthopaedic Surgery, University of Texas Health San Antonio, San Antonio, TX.
Background:
Open reduction and internal fixation (ORIF) of geriatric ankle fractures is associated with infection and wound-related complications, especially in patients with decreased functionality and increased comorbidity. The purpose of this study was to propose a risk-related score to anticipate the development of surgical site infection (SSI) and/or wound complications after ORIF of surgical ankle fractures among frail, elderly patients.
Methods:
A national database was queried for elderly patients undergoing ORIF for lateral malleolar, bimalleolar, and trimalleolar ankle fractures. Risk indices included age, the revised risk analysis index, and the geriatric nutritional risk index. Outcomes included 30-day SSI, wound dehiscence, and readmission. Established weights were generated for predictive variables (comorbidities, preoperative values) through backstep logistic regression to yield a frail ankle infection risk (FAIR) score for wound and infectious complications. Multivariable analysis assessed associations of indices with outcomes through odds ratio (OR) and confidence interval (CI). Discriminatory accuracy was quantified by receiver operating characteristic curve analysis.
Results:
A total of 3,383 patients underwent ankle fracture ORIF. 2.4% of patients developed SSI or wound dehiscence. The regression model generated the FAIR score, which demonstrated association with any complication (OR: 2.1; 95% CI, 1.4 to 3.1) and infection-related or wound-related complications (OR: 3.2; 95% CI, 1.9 to 5.4). The FAIR score had good discrimination for wound and infectious complications (area under the curve [AUC] = 0.814), whereas the geriatric nutritional risk index (AUC: 0.500), age (AUC: 0.506), and the revised risk analysis index (AUC: 0.517) demonstrated poor discrimination.
Conclusions:
ORIF for ankle fractures is associated with increased rates of wound-related and infection-related perioperative complications among frail patients with predisposing factors. This score may provide additional understanding of the factors associated with complications and expose additional areas for perioperative optimization to include surgical techniques in this patient population.
Level Of Evidence:
III.
