title: Early complications of surgery in operative treatment of ankle fractures in those over 60: a review of 186 cases.
abstract: BACKGROUND
  Ankle fractures are among the most common injuries of the lower extremity encountered by orthopaedic surgeons. With increasing population age and osteoporosis, the prevalence of these fractures is expected to increase. The aim of this study was to evaluate complications and the need for revision surgery after the surgical treatment of ankle fractures in patients over 60 years of age. We report the outcomes of 186 consecutive patients who underwent operative treatment for rotational ankle fractures in our institution from 2007 to 2010.
  
  
  METHODS
  Data were collected retrospectively for the purpose of this study. The outcome measures included minor complications which did not need further surgical intervention, that is, superficial wound infections, delayed wound healing, prominent implants and skin irritation, and major complications that prompted surgical intervention (due to deep wound infection, loosening of implants or loss of fixation). Medical complications were also recorded. Long-term complications (postoperative osteoarthritis) were not assessed in this study. Logistic regression analysis and Fisher's exact test were used to identify factors predicting higher risk of complications.
  
  
  RESULTS
  The average age was 70.67 years (standard deviation (SD) 7.40). There were 132 (71%) females and 54 (29%) males. The overall rate of complications was 21.5% with 10.8% of them being major complications prompting surgical intervention for wound washout, removal of implants and revision of fixation. Statistical analysis showed that smoking, age, diabetes, local factors (osteopaenia, peripheral neuropathy, peripheral vascular disease, lymphoedema and venous insufficiency) and modified Charlson score were significantly associated with occurrence of complications. Gender had a marginally significant effect. Coronary artery disease and fracture type (Weber classification) did not have a significant effect on the outcome.
  
  
  CONCLUSIONS
  Our data show that surgical treatment of ankle fractures in the elderly is associated with a high rate of complications. The factors predicting a high rate of complications include smoking, age, diabetes, local factors and a higher modified Charlson score. It is important to bear the factors in mind whilst deciding whether surgical treatment should be used in the treatment of such fractures in the elderly and explains these to patients at the time of obtaining consent. Further large-scale studies are needed to validate the predictive value of the suggested modified Charlson score.
authors.affiliation: West Suffolk Hospital, Hardwick Lane Bury St. Edmunds, Suffolk IP33 2QZ, UK; Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, UK.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Zaghloul
authors.affiliation: West Suffolk Hospital, Hardwick Lane Bury St. Edmunds, Suffolk IP33 2QZ, UK; University College London, Institute of Orthopaedic and Musculoskeletal Sciences, Royal National Orthopaedic Hospital Stanmore, Middlesex HA7 4LP, UK. Electronic address: behrooz.haddad@gmail.com.
authors.forename: Behrooz
authors.initials: B
authors.lastname: Haddad
authors.affiliation: Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Barksfield
authors.affiliation: Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, UK.
authors.forename: Ben
authors.initials: B
authors.lastname: Davis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016512:Ankle Injuries / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D015897:Comorbidity; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects*; D050723:Fractures, Bone / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D006299:Health Services for the Aged; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Ankle fracture; Complications; Elderly; Outcomes; Surgery