Predictors of first-year postoperative complications after fixation of low-energy ankle fractures: A single-center, retrospective cohort study of 663 consecutive fractures

Rev Esp Cir Ortop Traumatol. 2024 Jul-Aug;68(4):T363-T372. doi: 10.1016/j.recot.2024.01.029. Epub 2024 Feb 5.
[Article in English, Spanish]

Abstract

Introduction: Rotational ankle fractures are common, have diverse personalities and affect both robust and fragile patients. Postoperative complications are frequent, creating a sizeable economic burden. The primary purpose of this study was to expand current knowledge on predictors of postoperative complications after low-energy ankle fracture fixation.

Materials and methods: A retrospective single-center cohort study was completed of patients undergoing internal fixation OF low-energy ankle fractures. The primary outcome was first-year postoperative complications, classified as major (surgical) or minor (non-surgical). Data on patients, their injuries, and treatments were collected. To identify potential predictors of outcomes, logistic regression methods were used, with a backward-stepwise method used for model fitting.

Results: In total, 663 patients of median age 59 years were analysed. We found a high rate of complications (28.4%), with wound-healing issues and infections predominant. Overall, 14.8% had minor complications, while 13.6% required an unplanned reoperation. On multivariable analysis, the most consistent predictors of complications were older age (OR: 1.02 per year), longer operating time (3.32 per hour), and smoking (2.91).

Conclusions: Older patients and smokers who sustain fractures requiring more complex surgery are at higher risk of postoperative complications.

Keywords: Ankle fracture; Complicaciones; Complications; Factores de riesgo; Fractura de tobillo; Fractura maleolar; Malleolar fracture; Predictores; Predictors; Reintervención; Reoperation; Risk factors.