title: Complications after open reduction and internal fixation of ankle fractures in the elderly.
abstract: BACKGROUND
  Open reduction with internal fixation for unstable ankle fractures is relatively predictable with excellent outcomes. However, the management of ankle fractures in the elderly remains less predictable secondary to the various co-morbidities associated with advanced age.
  
  
  METHODS
  A retrospective chart review of 216 patients over the age of 60 that sustained an ankle fracture, was performed to determine the incidence of complications after ORIF of ankle fractures in an elderly population in the perioperative course. Secondly, the incidence of complications in patients that had locking plate fixation compared to those that had non-locking plate fixation was determined. Lastly, the effect of early weight bearing on the incidence of complications was analyzed.
  
  
  RESULTS
  There was not a statistically significant difference in the complication rates between the group with co-morbidities (19.01%) and those without (11.96%). The postoperative complication with the highest incidence was wound dehiscence (9.7%), and only diabetes significantly predicted wound dehiscence. The fixation construct and weight-bearing protocol failed to significantly predict any of the indexed complications.
  
  
  CONCLUSIONS
  Overall, the results suggest that surgical treatment of unstable ankle fractures in the elderly is fairly predictable with an acceptable complication rate. The complication rates are higher with increased age and diabetes, but they failed to reach statistical significance. Conventional plating appears to provide adequate stability without increased risk of hardware failure. In addition patients that were allowed to walk within the first 2 weeks postoperatively did not experience a higher rate of hardware failure.
authors.affiliation: San Francisco Bay Area Foot and Ankle Residency Program, Department of Orthopedics and Podiatric Surgery, Kaiser Permanente Medical Center, Oakland, CA 94118, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Lynde
authors.forename: Travis
authors.initials: T
authors.lastname: Sautter
authors.forename: Graham A
authors.initials: GA
authors.lastname: Hamilton
authors.forename: John M
authors.initials: JM
authors.lastname: Schuberth
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016512:Ankle Injuries / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects* / Q000379:methods; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies