Study Reviews Complications after Ankle Fracture in Elderly Patients

For Release: January 29, 2008
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Peggy Reilly
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Rosemont, IL – A recent study published in Foot & Ankle International, the official journal of the American Orthopaedic Foot & Ankle Society, has explored the controversy over the risks and benefits of ankle fracture treatment in elderly patients. The study, published in the December 2007 issue, was conducted with co-author Paul J. Hecht, MD, orthopaedic foot and ankle surgeon at Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire.

Ankle fractures are among the more common fractures sustained by elderly patients. This study used the United States Medicare database to determine the complication rate for ankle fractures in elderly patients treated operatively and to compare those results to fractures treated nonoperatively. The authors' hypothesis was that operatively treated ankle fractures in elderly patients would not have a higher complication rate than those treated nonoperatively. The Medicare National Claims History System data from 1998 - 2001 was utilized. From a 20% sample of all Medicare Part B beneficiaries, 33,704 patients with ankle fractures were identified. Their outcomes were evaluated at numerous time points. 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 treatment. Covariates included patient age, gender, race, medical comorbidity status, and fracture type. Dr. Hecht noted, "It was found that male patients were at greater risk for complications and mortality than female patients which is similar to the statistics reported after hip fractures."

After adjusting for the effects of the covariates, patients treated nonoperatively had significantly higher mortality than those treated operatively at all time periods except for 30 days. The difference in mortality between the two groups remained stable over time. After one year, patients whose ankle fractures were treated operatively had a mortality of 6.7% compared to 9.2% for those treated nonoperatively. At the two-year point, these rates were 11.3% versus 16.1% respectively.

Although associated with lower mortality, patients treated operatively had significantly higher rehospitalization rates (p < 0.05) at all time periods studied than nonoperative patients with the biggest difference in the first 30 days. It's not surprising that this would occur due to the risk of postoperative complications. 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 operative group of patients, a relatively small number had additional procedures. Eleven percent had removal of hardware with less than 1% of all patients having revision of the internal fixation, arthroplasty, arthrodesis, or amputation.

Interestingly, this study found that complication rates after ankle fractures in elderly patients were low regardless of whether the treatment was operative or nonoperative. It is the first study to report longer-term mortality after an ankle fracture in the elderly patients. "Surgical intervention for elderly patients with ankle fractures should be considered and not declined simply because of one's age," Dr. Hecht stated.

Dr. Hecht is a member of the American Orthopaedic Foot & Ankle Society. The Society promotes quality, ethical and cost-effective patient care through education, research and training of orthopaedic surgeons and other health care providers. The AOFAS creates public awareness for the prevention and treatment of foot and ankle disorders. It provides leadership and serves as a resource for government, industry and the national and international health care community.

To find an AOFAS orthopaedic foot and ankle surgeon in your area, go to www.aofas.org.