Complications following surgical treatment of posterior malleolar fractures: an analysis of 300 cases

Abstract

Aims The treatment of ankle fractures and fracture-dislocations involving the posterior malleolus (PM) has undergone considerable changes over the past decade. The aim of our study was to identify risk factors related to the occurrence of complications in surgically treated ankle fractures with PM involvement. Patients and methods We retrospectively analyzed 300 patients at a mean age of 57 years with 300 ankle fractures involving the PM treated surgically at our institution over a 12-year period. The following relevant comorbidities were noted: arterial hypertension (43.7%; n = 131), diabetes mellitus (DM) (14.0%; n = 42), thereof insulin-dependent (3.7%; n = 11), peripheral vascular disease (0.7%; n = 2), osteoporosis (12.0%; n = 36), dementia (1.0%; n = 3), and rheumatoid arthritis (2.0%; n = 6). Furthermore, nicotine consumption was recorded in 7.3% (n = 22) and alcohol abuse in 4.0% (n = 12). Results Complications occurred in 41 patients (13.7%). A total of 20 (6.7%) revision surgeries had to be performed. Patients with DM (p < 0.001), peripheral vascular disease (p = 0.003) and arterial hypertension (p = 0.001) had a significantly increased risk of delayed wound healing. Alcohol abuse was associated with a significantly higher overall complication rate (OR 3.40; 95% CI 0.97–11.83; p = 0.043), increased rates of wound healing problems (OR 11.32; 95% CI 1.94–65.60; p = 0.001) and malalignment requiring revision (p = 0.033). The presence of an open fracture was associated with an increased rate of infection and wound necrosis requiring revision (OR 14.25; 95% CI 2.39–84.84; p < 0.001). Multivariate analysis identified BMI (p = 0.028), insulin-dependent DM (p = 0.003), and staged fixation (p = 0.043) as independent risk factors for delayed wound healing. Compared to the traditional lateral approach, using the posterolateral approach for fibular fixation did not lead to increased complication rates. Conclusions Significant risk factors for the occurrence of complications following PM fracture treatment were identified. An individually tailored treatment regimen that incorporates all risk factors is important for a good outcome.

Incidence and Risk Factors for Surgical Site Infection in Ankle Fractures: An Observational Study of 480 Patients in Sweden

“…Similarly, Neuman et al stated that there was an increased risk of complication postoperatively in posterior malleolus fractures when insulin-dependent diabetes mellitus was present ref. [32]. The current data was not controlled for this possible confounding.…”

Joint-Preserving Osteotomy of the Lateral Tibial Plafond for Posttraumatic Osteonecrosis: A Prospective Cohort Study

“…However, 5 of 10 patients were smokers, suggesting a negative influence of smoking on local circulation and bone healing following ankle fractures as suggested by earlier studies. 3,32 This study has the inherent limitations resulting from a small patient number because of the rarity of the condition. The patient cohort was heterogeneous, there is a risk of selection bias, and there was no control group.…”

“…However, 5 of 10 patients were smokers, suggesting a negative influence of smoking on local circulation and bone healing following ankle fractures as suggested by earlier studies. 3 , 32 …”

Ankle fracture surgery in patients experiencing homelessness: a national evaluation of one-year rates of reoperation

“…Although it is well-known that health disparities exist among homeless people, 2 no study has characterized the prevalence of preoperative risk factors in homeless patients undergoing orthopedic trauma surgery. In this study, homeless patients had higher rates of several established risk factors for complications following ankle fracture surgery, including comorbidities that impede wound healing (ie, peripheral vascular disease and hypertension), [22][23][24][25] psychological disorders (ie, substance, tobacco, and alcohol use), 24,[26][27][28][29] and injury characteristics indicative of soft tissue compromise (ie, open fracture and fracture-dislocation). 22,25,30,31 Other factors associated with reoperation following ankle fracture surgery that were more prevalent among homeless patients were male sex, younger age, and having Medicaid insurance.…”