Foot & Ankle Orthopaedics · Published 2026-07-01 · DOI 10.1177/24730114261464628
Dhruv Mendiratta, Halyn Xheraj, Priyanka Mehta, Shriyaus Lingam, Avani Chopra, Gnaneswar Chundi, Abhiram Dawar, Constantine Sedereas, David Reiter, Michael Aynardi, Sheldon Lin
Background: The optimal operative timing for geriatric ankle fractures remains controversial, particularly in patients with significant comorbidities. Although delayed fixation may allow for medical optimization, its association with postoperative systemic complications is not well defined. Methods: A retrospective cohort study was performed using the Nationwide Readmissions Database (2016-2021). Patients aged 65 years and older undergoing open reduction and internal fixation for bimalleolar or trimalleolar ankle fractures were identified. Patients were stratified by operative timing into early (≤2 days) and delayed (>2 days) fixation groups. Propensity score matching was used to balance baseline characteristics. Postoperative medical complications, in-hospital mortality, length of stay, and readmission rates were compared between groups. Results: A total of 73 956 patients met inclusion criteria, with 61 829 undergoing early fixation and 12 127 undergoing delayed fixation. In the matched cohort, delayed fixation was associated with higher rates of sepsis (4.1% vs 1.0%, P < .001), pneumonia (5.3% vs 1.8%, P < .001), acute kidney failure (23.8% vs 13.3%, P < .001), acute heart failure (3.9% vs 1.3%, P < .001), atrial fibrillation (18.8% vs 13.8%, P < .001), and urinary tract infection (14.7% vs 8.2%, P < .001). In-hospital mortality was higher in the delayed fixation group (1.3% vs 0.6%, P = .002). With the numbers available, no significant difference could be detected in rates of pulmonary embolism or deep vein thrombosis ( P = .417). Delayed fixation was also associated with increased length of stay (10.13 days vs 4.71 days, P < .001). Conclusion: In a propensity-matched cohort of geriatric patients, delayed operative fixation of ankle fractures was associated with systemic medical complications, prolonged hospitalization, and higher in-hospital mortality. These findings should be interpreted as hypothesis-generating associations, as causation cannot be established and the observed associations may reflect underlying clinical complexity of patients requiring delayed intervention. Level of Evidence: Level III, retrospective cohort study.
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Mendiratta, D., Xheraj, H., Mehta, P., et al. (2026). Early vs Delayed Fixation and Systemic Complications in Geriatric Ankle Fractures: A Retrospective Cohort Study. Foot & Ankle Orthopaedics. https://doi.org/10.1177/24730114261464628