Open and closed ankle fracture treatment in Japanese nonagenarians and octogenarians: Mortality, surgical site infections and readmissions.

BACKGROUND

Several publications have suggested that elderly patients with open ankle fractures may have grave prognosis in terms of mortality, similarly to elderly patients with hip fractures. In this study we evaluated the effect of open ankle fractures on patient mortality in elderly population, including octogenarians and nonagenarians.

METHODS

This retrospective cohort included all patients above the age of 60 treated in Japan public emergency care hospitals between the years 2010 and 2018. Patients with lateral malleolus, medial malleolus, bimalleolar, trimalleolar and pilon fractures were included. The outcomes were mortality, length of hospital stay, surgical site infections and readmissions within one year.

RESULTS

There was a total of 6766 patients ages above 60, of whom 6062 had closed fractures and 704 had open fractures. Open fractures were not associated with higher mortality than closed fractures. Patients with open fractures stayed in the hospital for longer time (median of 51 vs 37 days, p < 0.001), had higher rate of surgical site infections (5.3 % vs 1.7 %, p < 0.001) and a lower rate of readmissions (2.6 % vs 6.2 %, p < 0.001).

CONCLUSION

The study shows that elderly patients with open ankle fractures are hospitalized for longer time and experience a higher rate of surgical site infections. However, they do not experience excess short-term mortality in this study setting.

LEVEL OF EVIDENCE: IV (non-experimental study).