Zahra W, Seifo M, Cool P, Ford D, Okoro T. Clinical outcome of open ankle fractures in patients above 70 years of age. World J Orthop 2023; 14(7): 554-561 [PMID: 37485433 DOI: 10.5312/wjo.v14.i7.554]
Corresponding Author of This Article
Wajiha Zahra, MBBS, MSc, Doctor, Department of Trauma and Orthopedics, Royal Shrewsbury Hospital, Mytton Oak Road, Shrewsbury SY3 8XQ, United Kingdom. wajiha.zahra@nhs.net
Research Domain of This Article
Orthopedics
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. Jul 18, 2023; 14(7): 554-561 Published online Jul 18, 2023. doi: 10.5312/wjo.v14.i7.554
Clinical outcome of open ankle fractures in patients above 70 years of age
Wajiha Zahra, Mina Seifo, Paul Cool, David Ford, Tosan Okoro
Wajiha Zahra, Mina Seifo, David Ford, Tosan Okoro, Department of Trauma and Orthopedics, Royal Shrewsbury Hospital, Shrewsbury SY3 8XQ, United Kingdom
Paul Cool, David Ford, Tosan Okoro, Department of Trauma and Orthopedics, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry SY10 7AG, United Kingdom
Paul Cool, Department of Trauma and Orthopedics, Keele University, Stafford ST5 5BG, United Kingdom
Author contributions: Zahra W, Seifo M, and Cool P contributed to data collection; Zahra W and Cool P contributed to data analysis; Cool P and Ford D contributed to supervision; Ford D and Okoro T contributed to project idea; Zahra W contributed to writing the manuscript and literature review; Seifo M contributed to review the manuscript; Okoro T contributed to overall supervision.
Institutional review board statement: This project is registered with the audit department of Royal Shrewsbury Hospital.
Informed consent statement: This study is registered with the local audit department and patients data has been used as per the local trust guidelines. This authorization has no expiration date.
Conflict-of-interest statement: We declare no conflict of interest.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wajiha Zahra, MBBS, MSc, Doctor, Department of Trauma and Orthopedics, Royal Shrewsbury Hospital, Mytton Oak Road, Shrewsbury SY3 8XQ, United Kingdom. wajiha.zahra@nhs.net
Received: March 26, 2023 Peer-review started: March 26, 2023 First decision: May 25, 2023 Revised: June 6, 2023 Accepted: June 16, 2023 Article in press: June 16, 2023 Published online: July 18, 2023 Processing time: 113 Days and 18.1 Hours
Abstract
BACKGROUND
Open fractures of the ankle are complex injuries requiring multidisciplinary input and are associated with significant morbidity and mortality. However, data on the clinical outcomes of open ankle fracture management in patients older than 70 is minimal.
AIM
To evaluate the clinical outcomes following open ankle fracture management in patients older than 70. Our secondary aim is to look at predictors of poor outcomes.
METHODS
Following local research and audit department registration, 22 years of prospectively collated data from an electronic database in a district general hospital were assessed. All patients older than 70 years of age with an open ankle fracture requiring surgical intervention were identified. Demographic information, the nature, and the number of surgical interventions were collated. Complications, including surgical site infection (SSI), venous thromboembolic events (VTEs) during hospital stay, and mortality rate, were reviewed.
RESULTS
A total of 37 patients were identified (median age: 84 years, range: 70-98); n = 30 females median age: 84 years, range: 70-97); n = 7 males median age: 74 years, range: 71-98)) who underwent surgical intervention after an open ankle fracture. Sixteen patients developed SSIs (43%). Superficial SSIs (n = 8) were managed without surgical intervention and treated with antibiotics and regular dressing changes. Deep SSIs (n = 8; 20%) required a median of 3 (range: 2-9) surgical interventions, with four patients requiring multiple washouts and one patient having metalwork removed. VTE incidence was 5% during the hospital stay. Eight patients died within 30 d, and mortality at one year was 19%. The 10-year mortality rate was 57%. The presence of a history of stroke, cancer, or prolonged inpatient stay was found to be predictive of lower survivorship in this population (log-rank test: cancer P = 0.008, stroke P = 0.001, length of stay > 33 d P = 0.015). The presence of a cardiac history was predictive of wound complications (logistic regression, P = 0.045). Age, number of operations, and diabetic history were found to be predictive of an increase in the length of stay (general linear model; age P < 0.001, number of operations P < 0.001, diabetes P = 0.041).
CONCLUSION
An open ankle fracture in a patient older than 70 years has at least a 20% chance of requiring repeated surgical intervention due to deep SSIs. The presence of a cardiac history appears to be the main predictor for wound complications.
Core Tip: There is no standard consensus on management of open ankle fractures in patients above 70 years of age. Cardiac issues are the main predictors of poor outcome. 1 in 5 patients above 70 years of age develop deep infection requiring further surgical intervention. High infection increases length of stay in the hospital and mortality.
