Complications after Ankle Fracture in Elderly Patients
Dartmouth Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA. Foot & Ankle International
(Impact Factor: 1.51).
12/2007; 28(12):1249-55. DOI: 10.3113/FAI.2007.1249
Controversy exists regarding the risks and benefits of ankle fracture treatment in elderly patients. The purpose of this study was to use the United States Medicare database to determine the complication rate for ankle fractures in elderly patients treated operatively and to compare it to fractures treated nonoperatively.
We used the National Medicare Claims History System to study all enrollees who sustained ankle fractures between 1998 and 2001. A total of 33,704 patients were identified and their outcomes at numerous time points were evaluated. These outcomes included mortality, rate of repeat hospitalization, rate of medical and operative complications, and the rate of additional surgery. The predictor variables were either nonoperative or operative intervention. Covariates included patient age, gender, race, medical comorbidity status, and fracture type.
Patients treated nonoperatively had significantly higher mortality (p < 0.05) than those treated operatively at all time periods except for 30 days. However, patients treated operatively had significantly higher rehospitalization rates (p < 0.05) at all time periods studied. The medical and operative complication rates at all time periods were less than or equal to 2% for patients who had either operative or nonoperative treatment. In the group that had operative management, a relatively small number of patients had additional procedures. Eleven percent had removal of hardware. Less than 1% of all patients had revision of the internal fixation, arthroplasty, arthrodesis, or amputation.
In properly selected cases, the complication rates of both operatively and nonoperatively treated elderly patients are low.
Available from: Roman A Hayda
- "Multivariable analysis discovered several other variables associated with mortality. Patients who underwent operative fixation within one month exhibited a decrease mortality risk, which is in concordance with the current literature on management of geriatric ankle fractures . Patients readmitted to the hospital within 30 days of discharge were also at Fig. 1 "
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The incidence of geriatric ankle fractures will undoubtedly increase as the population continues to grow. Many geriatric patients struggle to function independently after such injury and often require placement into nursing homes. The morbidity and mortality associated with nursing homes is well documented within the field of orthopaedic surgery. However, there is currently no study examining the mortality associated with nursing home placement following hospitalization for an ankle fracture. Therefore, the purpose of this study was to determine if geriatric patients admitted to nursing homes following an ankle fracture experience elevated mortality rates.
Patients were identified using diagnosis codes for ankle fractures from all 2008 part A Medicare claims, and those admitted to nursing homes were identified using a Minimum Data Set (MDS). The Medicare database was also analyzed for specific variables including over-all one year mortality, length of stay, age distribution, certain demographical characteristics, incidence of medical and surgical complications within 90 days, and the presence of comorbidities. Multivariate logistic regression analysis was used to determine if patients admitted to nursing homes had elevated mortality rates.
19,648 patients with ankle fractures were identified, and 11,625 (59.0%) of these patients went to a nursing home after hospitalization. Patients who went to a nursing home had higher Elixhauser and Deyo-Charlson comorbidity scores (p<0.0001). Nursing home patients also had significantly increased rates of postoperative medical and surgical complications. One year mortality was 6.9% for patients who did not go to a nursing home and 15.4% for patients who were admitted to a nursing home (p<0.0001). However, multivariate logistic regression analysis demonstrated no significant difference in one year mortality between patients admitted to nursing homes and those who were not (OR=1.1; 95% CI 0.99-1.24, p>0.05).
Although admission to nursing home was significantly associated with increased mortality in a bivariate statistical model, this significance was lost during multivariate analysis. This suggests that other patient characteristics may play a more prominent role in determining one year mortality following geriatric ankle fractures.
Available from: Mikko T Ovaska
- "Geriatric patients provide unique challenges in fracture management due to their bone quality and medical comorbidities (Little et al. 2013). SSI is a strong predictor of mortality in elderly patients (Lee et al. 2006), and controversies remain regarding the risks and benefits of operative treatment in geriatric patients (Koval et al. 2007, Strauss and Egol 2007, Hak et al. 2011, Shivarathre et al. 2011, Lynde et al. 2012, Little et al. 2013, McKean et al. 2013, Olsen et al. 2013, Zaghloul et al. 2014). The risks of surgical treatment should be carefully evaluated in all elderly patients (Kettunen and Kröger 2005). "
Available from: sciencedirect.com
- "Two large-sample multicentre studies reported the outcomes of ankle fracture fixation in the elderly and identified factors that predict poor outcomes of ankle fractures in the elderly  . Koval et al.  studied 33,704 patients with either non-operative or operative treatment. Patients treated non-operatively had significantly higher mortality, but this could have been due to a selection bias as healthier patients were chosen for operative treatment. "
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ABSTRACT: Ankle fractures are among the most common injuries of the lower extremity encountered by orthopaedic surgeons. With increasing population age and osteoporosis, the prevalence of these fractures is expected to increase. The aim of this study was to evaluate complications and the need for revision surgery after the surgical treatment of ankle fractures in patients over 60 years of age. We report the outcomes of 186 consecutive patients who underwent operative treatment for rotational ankle fractures in our institution from 2007 to 2010.
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