title: Comparison of Early Adverse Events After Operative Treatment of Bimalleolar and Trimalleolar Fractures Versus Pilon Fractures.
abstract: Ankle fractures requiring open reduction and internal fixation vary in severity from unimalleolar fractures to bimalleolar/trimalleolar (BT) fractures to pilon fractures. Consequently, the postoperative outcomes with these surgeries can vary. Most previous studies of these injuries had small sample sizes, studied a single risk factor or adverse event, or did not compare different injuries by severity. The purpose of the present study was to describe and compare the patient characteristics and postoperative outcomes of 2 high-energy ankle fractures: BT and pilon fractures. The relevant patients were identified from the American College of Surgeons National Surgical Quality Improvement Program database using the Current Procedural Terminology codes for BT and pilon fractures. Patient demographics, characteristics, comorbidities, and 30-day mortality and adverse events were recorded and compared between the 2 types of ankle fractures. More than 45% of patients with these fracture types were aged 40 to 65 years. Pilon fractures occurred more frequently in younger patients, were more likely to occur in men, required a longer hospital stay and operative time, were less likely to occur in patients with a body mass index of >30 kg/m2, and conferred a greater risk of wound complications (odds ratio 1.76; p = .048) compared with BT fractures. The findings from the present study help us understand the differences in patient characteristics and potential early adverse events after open reduction and internal fixation of BT fractures versus pilon fractures.
authors.affiliation: Chief Orthopaedic Resident, Division of Orthopaedic Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Karim Z
authors.initials: KZ
authors.lastname: Masrouha
authors.affiliation: Associate Professor of Medicine, Director of the Biostatistics Unit, Clinical Research Unit, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Hani
authors.initials: H
authors.lastname: Tamim
authors.affiliation: Associate Professor of Clinical Surgery, Division of Orthopaedic Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Assad
authors.initials: A
authors.lastname: Taha
authors.affiliation: Instructor of Clinical Surgery, Division of Orthopaedic Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Abdel Majid
authors.initials: AM
authors.lastname: Sheikh Taha
authors.affiliation: Medical Student, Faculty of Medicine, American University of Beirut, Beirut, Lebanon.
authors.forename: Racha
authors.initials: R
authors.lastname: Abi-Melhem
authors.affiliation: Assistant Professor of Clinical Surgery, Assistant Director of Operating Room Administration, Division of Orthopaedic Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon. Electronic address: maltaki@aub.edu.lb.
authors.forename: Muhyeddine
authors.initials: M
authors.lastname: Al-Taki
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D064386:Ankle Fractures / Q000145:classification* / Q000453:epidemiology* / Q000601:surgery; D015992:Body Mass Index; D015331:Cohort Studies; D016208:Databases, Factual; D006801:Humans; D007902:Length of Stay; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications; D012189:Retrospective Studies; D017678:Sex Distribution; D012907:Smoking / Q000453:epidemiology; D014481:United States / Q000453:epidemiology
keywords: ankle fracture; malleolus; morbidity; mortality; plafond fracture; postoperative outcome