Clinical Outcomes of Trimalleolar Ankle Fractures in Patients Aged 65 Years and Older

Purpose: To evaluate clinical and radiographic outcomes after the surgical treatment of trimalleolar ankle fractures in patients aged 65 years and to identify the prognostic factors for poor clinical outcomes.Materials and Methods: Sixty-three patients aged 65 years who underwent surgery for trimalleolar ankle fractures (2013~2022) were reviewed retrospectively.Pathologic fractures, open fractures, and follow-up <6 months were excluded.The candidate prognostic variables included the demographics, fracture classification (Lauge-Hansen and Danis-Weber), bone mineral density, body mass index, comorbidities, associated injuries, posterior malleolar fixation status, and syndesmotic injury.The reduction quality was graded using the Burwell-Charnley criteria.The outcomes were the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score and final ambulation status.The continuous variables were compared using Student's t-test or the Mann-Whitney U-test, and the categorical variables were analyzed using the chi-square test or Fisher's exact test, where appropriate.Multivariable logistic regression was performed to identify the independent prognostic factors for poor clinical outcomes.Results: The mean age was 73.4 years, and the mean follow-up was 14.8 months; 39 patients were male, and 24 were female.Radiographic reduction was anatomic in 81.0% and fair in 19.0%.The mean time to union was 5 months, and the mean AOFAS score was 82.4.Final ambulation, limping gait, cane use, and wheelchair use were normal in 23.8%, 47.6%, 22.2%, and 6.3%, respectively.Infection and delayed union occurred in 6.3% and 9.5%, respectively, with no cases of nonunion or peri-implant fracture.Multivariable analysis showed that comorbidities and associated injuries were independently associated with poor clinical outcomes.Conclusion: Surgical treatment generally achieved satisfactory radiographic reduction and union in patients aged 65 years, but functional recovery was variable, and many patients required walking aids.Comorbidities and concomitant injuries independently predicted poor outcomes, underscoring the importance of careful perioperative risk assessment and multidisciplinary postoperative management in this population.