Ankle fractures in the elderly associated with low complication rate, regardless of treatment type

However, patients treated nonoperatively had significantly higher mortality at all time points except at 30 days follow-up.

Ankle fractures in elderly patients are associated with a low rate of complications, regardless of whether the fractures are treated operatively or nonoperatively.

"Surgical intervention for elderly patients with ankle fractures should be considered and not declined simply because of one's age," Paul J. Hecht, MD, one of the co-authors of a recent study on ankle fractures, said in a press release announcing the findings.

Hecht, Kenneth J. Koval, MD, and colleagues from Dartmouth-Hitchcock Medical Center in Lebanon, N.H., reviewed data from the United States Medicare National Claims History System database to determine the complication rate for ankle fractures in elderly patients. They then compared complication rates between patients treated either operatively or nonoperatively. All patients had been treated between 1998 and 2001, according to the study, published in Foot & Ankle International.

The authors' hypothesized that fractures treated operatively would have a lower complication rate than those treated nonoperatively.

From a 20% sample of all Medicare Part B beneficiaries, investigators identified 33,704 patients with ankle fractures.

Outcomes evaluated included mortality, rate of repeat hospitalization, rate of medical and operative complications, and the rate of additional surgery. The predictor variables included either nonoperative or operative treatment; covariates included patient age, gender, race, medical comorbidities and fracture type.

After adjusting for the effects of the covariates, the researchers found that patients treated nonoperatively had significantly higher mortality than those treated operatively at all time points (P < .05) except at 30 days follow-up, according to the study.

"However, patients treated operatively had significantly higher rehospitalization rates (P < .05) at all time periods studied," the authors noted.

The difference in mortality between the two groups remained stable over time. After 1 year, patients who underwent surgery had a 6.7% mortality rate compared to 9.2% for those treated conservatively. At 2 years, operatively treated patients had an 11.3% mortality rate vs. a 16.1% mortality rate for nonoperatively treated patients, according to the press release.

At all time periods, there was a 2% or lower rate of either medical or operative complications for patients treated either operatively or nonoperatively.

Of the patients treated with surgery, a "relatively small" number had additional procedures, which included hardware removal in 11% of cases, the authors wrote.

"Less than 1% of all patients had revision of the internal fixation, arthroplasty, arthrodesis or amputation," they noted.

Also, "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," Hecht said in the press release.

For more information:
Koval KJ, Zhou W, Sparks MJ, et al. Complications after ankle fracture in elderly patients. Foot Ankle Int. 2007;28:1249-1255.