Clinical outcome of open ankle fractures in patients above 70 years of age

doi:10.5312/wjo.v14.i7.554

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World Journal of Orthopedics

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2218-5836

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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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.

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

ARTICLE HIGHLIGHTS

Research background

There is no data on the clinical outcomes of patients older than 70 admitted with open ankle fractures. This study sets the foundation for future research trials in elderly population.

Research motivation

This is the only study looking at patients older than 70 with open ankle fractures. This study highlights the multiple factors which can predict the poor outcome in this age group with open ankle fractures. There is no consensus on the best management strategy for these injuries in this population.

Research objectives

The overall objective of this study is to look at the predictors of poor clinical outcome in patients older than 70 with open ankle fractures.

Research methods

This is a retrospective observational study performed on 22 years of prospectively collated data from an electronic database in a district general hospital. We used R 4.2.2 (R foundation) to perform statistical analysis.

Research results

We identified 37 patients above 70 years of age admitted over the period of 22 years with an open ankle fractures. Sixteen patients developed deep surgical site infections, with 4 requiring multiple wash outs. Eight patients developed superficial surgical site infections and were managed with antibiotics and regular dressing change. The 10 years mortality rate in this age group was 57%. The presence of a cardiac and stroke history, cancer, or prolonged inpatient stay were found to be the predictors of mortality.

Research conclusions

We concluded that there is a 20% risk of patients above 70 years of age with open ankle fracture requiring repeated surgical intervention. The need for repeated surgical interventions is mainly due to deep Surgical Site Infections. We identified multiple predictors for worse outcome. However, the presence of a cardiac history appears to be the main predictor for wound complications.

Research perspectives

This study sets the foundation for further research trials in patients above 70 years of age.