Impact of surgical intervention on ankle fractures in octogenarians and nonagenarians: a comprehensive outcome analysis.

Abstract

This study assesses clinical outcomes and quality of life (QoL) following surgical treatment of fragility ankle fractures in individuals aged over 80 years. We conducted a retrospective study involving 45 elderly patients who underwent surgery for fragility ankle fractures between 2015 and 2023. Pre-operative mobility was assessed using the Parker Mobility Score (PMS), and nutritional status was evaluated using a short-form mini-nutritional assessment (MNA-SF). The ASA classification and the age-adjusted Charlson Comorbidity Index (aCCI) were used to assess comorbidities affecting outcomes comprehensively. Primary outcomes included (1) Ankle function, measured by the Olerud-Molander Ankle Score (OMA-score), and (2) QoL, assessed through the EQ-5D-3 L index score, EQ-VAS, and Barthel Index. Any postoperative complications or mortality were considered secondary outcome. The cohort's mean age was 83.8 ± 3.2 years. At the one-year follow-up, the OMA-score negatively correlated with pre-operative days (p = 0.035), length of hospital stay (p = 0.047), and time to weight-bearing initiation (p < 0.001). Time to weight-bearing initiation negatively impacted the EQ-5D-3 L index (p = 0.001) and EQ-VAS (p < 0.001), whereas the Barthel Index showed positive correlations with pre-operative PMS (p = 0.005) and MNA-SF (p = 0.002). Surgical and non-surgical complication rates were 28.9 % and 31.1 %, respectively. The one-year survival rate was 75.6 %. Deceased patients had higher aCCI scores (p = 0.005), lower PMS (p < 0.001), and lower MNA-SF scores (p = 0.005); however, the ASA grade showed no significant difference (p = 0.066). The timing of weight-bearing initiation after ankle surgery may significantly influence ankle function and QoL in octogenarians and nonagenarians. Geriatric assessments, such as the PMS, MNA-SF, and aCCI, effectively assess mortality risk, whereas the ASA classification is less predictive.