Impact of preoperative osteoporosis on short- and long-term complications following ankle ORIF: A multi-institutional propensity-matched analysis.

BACKGROUND

Osteoporosis may impair fracture healing and fixation durability after ankle ORIF. This study evaluated postoperative complications of preoperative osteoporosis.

METHODS

Patients undergoing ankle ORIF from 2004 to 2022 with ≥ 2 years of follow-up were identified from a multi-institutional database. Those with and without preoperative osteoporosis, defined with ICD-10 code M80 & M81, were compared using 1:1 propensity score matching; outcomes were assessed at 90 days and 2 years.

RESULTS

Matched cohorts included 4190 patients. At 90 days, the osteoporosis group had higher device infection (1.0% vs. 0.5%; RR=2.10), DVT (1.4% vs. 0.8%; RR=1.63), and transfusion (1.9% vs. 1.1%; RR=1.63). At 2 years, device infection (2.6% vs. 1.4%; RR=1.80) and hardware removal (14.2% vs. 11.6%; RR=1.23) were elevated.

CONCLUSIONS

Osteoporosis is associated with increased short- and long-term complications after ankle ORIF; because these injuries are treated acutely, bone health optimization and fixation suited to osteoporotic bone are best addressed postoperatively.