Scripties UMCG - Rijksuniversiteit Groningen
English | Nederlands

Invloed van vaatstatus op complicaties na open reductie en interne fixatie van enkelfracturen bij ouderen

(2017) Lutfi, H.

Ankle fracture is one the most common fracture in the elderly and is associated with high morbidity and mortality. In most cases, ankle fractures can be treated conservatively, but in some cases of open reduction and internal fixation (ORIF) is needed. Just like all operations, this treatment has some complications inherent to it. The prevalence of complications following ORIF varies from 5-40%. In previous studies, risk factors for these complications have been identified. The main risk factors are peripheral arterial disease (PAD) and diabetes mellitus (DM). Other risk factors include age, male gender, smoking, open fractures and higher ASA-classification. The purpose of this study was to determine how often anything is known about the vascular status in the elderly patients who will undergo open reduction and internal fixation of an ankle fracture. The subquestion is whether there is a relation between a poor vascular status, among some other known risk factors and the occurrence of 2 complications in these patients. A poor vascular status is defined as an ankle brachial pulsatile index less than 0.8, a toe pressure less than 50 mmHg or significant stenosis on the arterial duplex of the leg.
Data of 178 patients were analyzed retrospectively. The primary outcome measure was development of complications, divided into mild (delayed wound healing, superficial wound infection and wound dehiscence) and serious (nonunion, deep wound infection, surgical re-intervention and amputation). The main predictive variable was vascular status. Vascular status was quantified into sufficient and insufficient based on ankle brachial pulsatile index (ABPI), arterial duplex and toe pressure. Univariate analysis identified risk factors. Hypertension, wound compromising medication, DM, PAD and age were significant risk factors. Multivariate regression analysis identified age, DM and PAD as independent risk factors. Vascular status was not included in regression analysis because of the low numbers.
In conclusion, poor vascular status is a risk factor for complications after ORIF of ankle fractures in the elderly. However, sample sizes were small in this retrospective study and therefore, we advise reproduction of results with larger sample sizes in a prospective study design.

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