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Impact of osteoporosis on outcomes following ankle open reduction and internal fixation
Prajwal Guruprasad1, Pranav Sivaram1, Conor O'Neill2
1College of Medicine, Northeast Ohio Medical University, Rootstown, OH, USA.
Objectives:
To determine whether osteoporosis is an independent risk factor for adverse postoperative outcomes following open reduction and internal fixation (ORIF) of ankle fractures in adults aged ≥ 50 years.
Methods:
Design: Retrospective cohort study using the TriNetX Research Network with 1:1 propensity score matching.
Setting:
Multicenter, international research setting using the TriNetX federated electronic health records database, which includes data from > 100 healthcare organizations across academic and non-academic institutions. Patient Selection Criteria: Adults aged ≥ 50 years who underwent ankle ORIF between January 1, 2004, and December 31, 2024, were identified using International Classification of Diseases, Tenth Revision (ICD-10) and Current Procedural Terminology (CPT) codes for ankle fractures and low-energy falls. Patients with pathologic fractures or additional non-ankle lower-extremity fractures were excluded. Two cohorts were created for comparison: patients with a prior diagnosis of osteoporosis and patients without prior diagnosis of osteoporosis. Outcome Measures and Comparisons: Postoperative complications, including malunion/nonunion/delayed healing, hardware failure or revision, readmission, infections, wound dehiscence, and pulmonary embolism, were assessed at 90 days, 1 year, and 3 years.
Results:
Across all time points, no statistically significant differences were observed between the osteoporotic and non-osteoporotic groups for most complications. Each group contained 2700 patients. Wound dehiscence at 90 days was significantly higher in the non-osteoporotic cohort (p = 0.015). All other outcomes showed no significant variation between groups.
Conclusion:
These results suggest that osteoporosis may not be an independent risk factor for poor surgical outcomes following ankle ORIF. When fixation is appropriately tailored to bone quality, including the use of locking plates and augmentation strategies, current fixation techniques appear sufficient for managing osteoporotic bone. Thus, preoperative planning should prioritize patient comorbidities and soft tissue condition along with bone mineral density.
