Department of Orthopaedic Surgery, Duke University Medical Center, 4709 Creekstone Drive, Durham, NC, 27703, USA.
Idaho Sports Medicine Institute, Boise, ID, USA.
Eur J Orthop Surg Traumatol. 2022 Jan;32(1):113-119. doi: 10.1007/s00590-021-02927-z. Epub 2021 Mar 23.
Ankle fractures are common orthopedic injuries with complication rates fixation of up to 40%. Limited evidence exists in the literature regarding complications in the elderly population, and moreover, these studies frequently define elderly arbitrarily at 60-65 years old. The purpose of the present study was to utilize a large, validated database to evaluate whether there is an inflection point of age when postoperative complications after an ankle fracture significantly increase.
A retrospective review of all patients in the American College of Surgeons National Surgical Quality Improvement Program database who underwent fixation of an ankle fracture between 2012 and 2018 was performed. Patients were identified within the database using the Current Procedural Terminology codes. Appropriate statistical analysis was performed with p value less than 0.05 considered statistically significant.
A total of 27,633 fractures were including and comprised of 221 posterior malleolar, 1567 medial malleolar, 8495 lateral malleolar, 10,175 bimalleolar, and 7175 trimalleolar. A total of 1545 complications were encountered (5.6%). There was a statistically significant association between increasing age and complications (OR = 1.03; p < 0.001). Further analysis shows the largest spike in complications within the age 78 + bracket. There were no overall interaction effects between age and fracture subtype (p = 0.223).
ORIF of ankle fractures is a common orthopedic procedure performed on patients of all ages, with complications ranging in severity. In order to best counsel patients on their individual postoperative risks, large datasets are often necessary to prognosticate. This study found that postoperative complications increase with advanced age. The incidence of complications did not spike for patients around the age of 65, but rather followed an incremental linear pattern with the largest increase in odds ratio occurring at age 78 and above. Complication rate was not associated with specific fracture type based off of ICD codes.
踝关节骨折是常见的骨科损伤，其并发症发生率高达 40%。文献中关于老年人群并发症的证据有限，而且这些研究通常将老年人任意定义为 60-65 岁。本研究的目的是利用一个大型的、经过验证的数据库，评估踝关节骨折固定术后并发症是否存在一个年龄拐点，当超过这个拐点时，术后并发症的发生率会显著增加。
对 2012 年至 2018 年期间在美国外科医师学院国家外科质量改进计划数据库中接受踝关节骨折固定术的所有患者进行回顾性分析。在数据库中使用当前程序术语代码识别患者。使用 p 值小于 0.05 认为具有统计学意义进行适当的统计分析。
共纳入 27633 例骨折，包括 221 例后踝骨折、1567 例内踝骨折、8495 例外踝骨折、10175 例双踝骨折和 7175 例三踝骨折。共发生 1545 例并发症（5.6%）。年龄与并发症之间存在显著的相关性（OR=1.03；p<0.001）。进一步分析显示，78 岁以上年龄段的并发症发生率最高。年龄与骨折亚型之间没有总体交互作用（p=0.223）。
切开复位内固定术是一种常见的骨科手术，适用于所有年龄段的患者，并发症的严重程度各不相同。为了更好地向患者提供个体化的术后风险预测，通常需要使用大型数据集进行预后判断。本研究发现，随着年龄的增长，术后并发症的发生率会增加。并发症的发生率并未在 65 岁左右的患者中突然增加，而是呈现出递增的线性模式，最大的优势比增加发生在 78 岁及以上的患者中。根据 ICD 编码，并发症发生率与特定的骨折类型无关。
