Patient Characteristics and Outcomes of Geriatric Ankle Fractures: Open Fracture Is the Key Risk Factor for Complications and Functional Decline.

OBJECTIVES: To determine whether open (O) or closed (C) geriatric ankle fractures had different patient characteristics or outcomes. METHODS: . DESIGN: Retrospective cohort study. SETTING: Urban Level 1 trauma center. PATIENT SELECTION CRITERIA: Patients, age 60 years and older, who underwent operative fixation of a rotational ankle fracture (OTA/AO 44A-C) between January 2012 and September 2021. OUTCOME MEASURES AND COMPARISONS: Morbidity, defined as 90-day reoperation, 90-day readmission, or loss of mobility, as well as 1-year mortality compared between patients with closed and open fractures. RESULTS: The open cohort was older (75 years vs. 68 years; P = 0.003) but had similar Charlson comorbidity indices (4.6 O vs. 4.0 C; P = 0.323) and preinjury rates of independent ambulation (70.4% O vs. 80.9% C; P = 0.363). There were higher rates of 1-year mortality (11% vs. 0%; P < 0.001), deep infection (14.8% vs. 3.9%; P = 0.019), and loss of mobility (64.7% vs. 23.0%; P < 0.001) in the open cohort. Multivariate regression identified open fracture as an independent predictor of 90-day reoperation (OR: 20.6; P = 0.022) and loss of mobility (OR: 5.1; P = 0.011). CONCLUSIONS: Despite having comorbidities and preinjury function similar to the closed geriatric ankle fracture cohort, open ankle fracture was independently predictive of greater loss of mobility. Nearly two-thirds of geriatric patients with open ankle fractures experienced a decline in functional independence, compared with 1 in 4 of those with closed fractures. Open fracture was associated with higher rates of deep infection, reoperation, and 1-year mortality. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Transmetatarsal Amputation Results in Higher Frequency of Revision Surgery and Higher Ambulation Rates Than Below-Knee Amputation.

Background: Selecting the level of amputation for patients with severe foot pathology can be challenging. The surgeon is sometimes confronted with an option between transmetatarsal amputation (TMA) and below-knee amputation (BKA). Recent studies have suggested that minor foot amputations have high revision rates and need for higher level of amputation. This study sought to compare the revision rates, need for higher level of amputation, postoperative ambulatory rate, and the demographic factors between these 2 operations. Methods: We retrospectively reviewed the records of patients undergoing either BKA or TMA at a single academic institution during an 8-year period. Demographic characteristics and medical history were collected and included in a binary logistic regression model to evaluate for independent predictors of needing revision surgery or needing higher-level amputation. Secondary outcomes included ambulatory status and wound status at last follow-up. Results: There was a total of 367 patients who underwent either BKA (n=293) or TMA (n=74).On binary logistic regression, the only significant independent predictor of needing revision surgery was undergoing TMA (odds ratio [OR] 2.30, CI 1.199-4.146, P = .011). The presence of PAD trended toward significance (OR 2.12, CI 0.99-4.493, P = .051). Similarly, significant independent predictors of needing higher level amputation were undergoing TMA (OR 4.117, CI 1.9-8.9, P < .001) and presence of PAD (OR 4.85, CI 1.59-14.85, P = .006). More TMA patients were ambulatory (56.8%) on last follow-up compared with BKA patients (30.9%). Conclusion: Transmetatarsal amputation has a higher risk of reoperation and need for revision amputation compared with below-knee amputation. Transmetatarsal amputation has a higher chance of returning patients to independent ambulation. Patients with peripheral arterial disease are at a higher risk of revision surgery and higher-level amputation with both operations. Level of Evidence: Level III, retrospective case review.