Outcomes of Ankle Fractures in Patients With Solid Organ Transplant

The prevalence of solid organ transplant (SOT) patients is rising, and orthopaedic surgeons will treat these patients in elective and traumatic settings. Ankle fractures are common orthopaedic injuries often treated with surgery. Because of organ dysfunctions and effects from immunosuppressive regimens, SOT patients may have higher complication rates postoperatively compared with non-SOT patients. However, there is minimal literature reporting on these injuries or the surgical outcomes in this population.

A retrospective case-control study was performed at a single institution to investigate postoperative outcomes of solid organ transplant (SOT) patients undergoing ankle procedures after injury. Current Procedural Terminology (CPT) codes were used to identify patients and their healthy, non-SOT matched controls. Charts were reviewed for infection, nonunion, wound dehiscence, readmission, discharge disposition, hospital length of stay (LOS), and operative time and compared between the 2groups. Generalized estimating equations (GEEs) accounted for the 3:1 matched design, analyzing continuous and categorical data via linear and logistic models, respectively.

In this study of 132 patients (33 SOT, 99 non-SOT matched controls), there were no differences in preoperative demographics (age, body mass index, Charlson Comorbidity Index), surgical characteristics (blood loss, procedure time), or postoperative characteristics (anticoagulation, antibiotics, LOS, discharge disposition) between groups. With the numbers available, no significant differences could be detected for 90-day emergency department (ED) visit (36.4% vs 38.4%, P = .846), readmission (30.3% vs 33.3%, P = .762), deep vein thrombosis (0% vs 1.0%, P = .562), pulmonary embolism (0% vs 0%, P = 1.000), or overall complications between groups (48.5% vs 27.3%, P = .137). SOT patients had a higher frequency of nonunion/delayed union (24.2% vs 3.0%, P < .001) and were more likely to undergo external fixation prior to definitive fixation (18.2% vs 5.1%, P = .018).

Patients with a history of SOT undergoing ankle procedures after injury did not show a significant difference in readmissions, ED visits, or overall complication rate after surgery compared with non-SOT patients. However, SOT patients did show a higher rate of delayed/nonunion after surgery. Close monitoring for union in SOT patients and a lower threshold for bone healing adjuvant therapies may be advantageous.

Level III, retrospective case-control study.