NS3 - FOOTAGE (Fracture Outcomes in Older Trauma - Ankle & Foot Geriatric Experience): A Multicenter Retrospective Cohort Study
SCURS Disciplines
Medicine & Health Sciences
Document Type
General Presentation (Oral)
Invited Presentation Choice
Not Applicable
Abstract
Purpose
Ankle fractures in older adults are increasingly common and associated with substantial morbidity. The purpose of this study was to characterize complication rates following surgically treated ankle fractures in an elderly population and to identify independent risk factors associated with adverse outcomes.
Methods
A multicenter retrospective cohort study across 9 institutions was performed of patients aged 60–100 years sustaining isolated ankle fractures managed operatively. Demographic characteristics, comorbidities, injury mechanisms, fracture patterns, and treatment details were collected. Patients were excluded for active malignancy, polytrauma requiring operative intervention, bilateral ankle fractures, pilon (distal tibial plafond) fractures, or preexisting ankle hardware. Outcomes included medical and orthopaedic complications, reoperations, and mortality. Unadjusted comparisons and multivariable logistic regression were performed to identify risk factors associated with adverse outcomes, with penalized regression used for visualization.
Results
A total of 434 operatively treated patients were included, with a mean age of 70.8 ± 8.2 years. The majority (73%) were female and most injuries (71%) resulted from low-energy ground-level falls. Common comorbidities included hypertension (68%), diabetes mellitus (29%), coronary artery disease (22%), and osteoporosis (12%). In this cohort, 129 (30%) experienced at least one complication. Medical complications occurred in 16% and orthopaedic complications in 17%, with some experiencing both. The most common orthopaedic complications were superficial (8%) and deep infection (5%). There were 7 nonunions (1.7%). Inpatient mortality was 0.4%. On multivariable analysis, increasing age (aOR 1.028, 95% CI 1.001-1.056), greater comorbidity burden (aOR 1.715, 95% CI 1.099-2.677), open fractures (aOR 2.128, 95% CI 1.186-3.819), and motor-vehicle injury (aOR 3.129, 95% CI 1.511-6.480) were independently associated with any complication. Open fractures were independently associated with orthopaedic complications (aOR 2.538, 95% CI 1.344-4.792), while increasing age (aOR 1.069, 95% CI 1.033-1.105), comorbidity burden (aOR 1.952, 95% CI 1.095-3.483), and motor-vehicle injury (aOR 3.500, 95% CI 1.543-7.939) were independently associated with medical complications.
Conclusion
Nearly one-third of operatively managed ankle fractures in older patients endure a medical and/or orthopaedic complication. Advanced age, comorbidities, open fractures, and high-energy mechanisms are significantly associated with increased risk of complications. These findings may aid in preoperative counseling, risk stratification, and perioperative optimization.
Keywords
Orthopedics; Trauma; Retrospective; Cohort; Geriatric
Start Date
10-4-2026 2:55 PM
Location
CASB 105
End Date
10-4-2026 3:10 PM
NS3 - FOOTAGE (Fracture Outcomes in Older Trauma - Ankle & Foot Geriatric Experience): A Multicenter Retrospective Cohort Study
CASB 105
Purpose
Ankle fractures in older adults are increasingly common and associated with substantial morbidity. The purpose of this study was to characterize complication rates following surgically treated ankle fractures in an elderly population and to identify independent risk factors associated with adverse outcomes.
Methods
A multicenter retrospective cohort study across 9 institutions was performed of patients aged 60–100 years sustaining isolated ankle fractures managed operatively. Demographic characteristics, comorbidities, injury mechanisms, fracture patterns, and treatment details were collected. Patients were excluded for active malignancy, polytrauma requiring operative intervention, bilateral ankle fractures, pilon (distal tibial plafond) fractures, or preexisting ankle hardware. Outcomes included medical and orthopaedic complications, reoperations, and mortality. Unadjusted comparisons and multivariable logistic regression were performed to identify risk factors associated with adverse outcomes, with penalized regression used for visualization.
Results
A total of 434 operatively treated patients were included, with a mean age of 70.8 ± 8.2 years. The majority (73%) were female and most injuries (71%) resulted from low-energy ground-level falls. Common comorbidities included hypertension (68%), diabetes mellitus (29%), coronary artery disease (22%), and osteoporosis (12%). In this cohort, 129 (30%) experienced at least one complication. Medical complications occurred in 16% and orthopaedic complications in 17%, with some experiencing both. The most common orthopaedic complications were superficial (8%) and deep infection (5%). There were 7 nonunions (1.7%). Inpatient mortality was 0.4%. On multivariable analysis, increasing age (aOR 1.028, 95% CI 1.001-1.056), greater comorbidity burden (aOR 1.715, 95% CI 1.099-2.677), open fractures (aOR 2.128, 95% CI 1.186-3.819), and motor-vehicle injury (aOR 3.129, 95% CI 1.511-6.480) were independently associated with any complication. Open fractures were independently associated with orthopaedic complications (aOR 2.538, 95% CI 1.344-4.792), while increasing age (aOR 1.069, 95% CI 1.033-1.105), comorbidity burden (aOR 1.952, 95% CI 1.095-3.483), and motor-vehicle injury (aOR 3.500, 95% CI 1.543-7.939) were independently associated with medical complications.
Conclusion
Nearly one-third of operatively managed ankle fractures in older patients endure a medical and/or orthopaedic complication. Advanced age, comorbidities, open fractures, and high-energy mechanisms are significantly associated with increased risk of complications. These findings may aid in preoperative counseling, risk stratification, and perioperative optimization.