INTRODUCTION: Malnutrition has emerged as a significant risk factor for postoperative complications in orthopaedic surgery. Despite this, the impact of malnutrition in orthopaedic trauma remains underexplored. This study aims to investigate 90 day and 1 year postoperative outcomes of ankle and pilon fracture open reduction and internal fixation (ORIF) in malnourished patients.
METHODS: Using a national database, adult patients who underwent surgery for ankle or pilon fractures with a minimum of one-year follow-up were identified. Patients were stratified into two cohorts based on the presence of serum markers for malnutrition within the year preceding surgery. Malnutrition was identified by any of the following values: serum or plasma transferrin ≤204 mg/dL, blood leukocytes ≤1.5 × 10³/µL, or albumin ≤3.5 g/dL. A 1:1 propensity score matching was performed with matched controls for relevant risk factors, demographics and comorbidities.
RESULTS: Before matching, 80,761 ankle fracture patients (7,455 malnourished; 73,306 controls) and 14,258 pilon fracture patients (1,648 malnourished; 12,610 controls) were identified. After matching, 14,676 ankle fracture (mean age 58.4 ± 16.9 years) and 3,214 pilon fracture (mean age 50.1 ± 17.2 years) patients were included. In the ankle fracture analysis, malnourished patients had higher rates of wound complications, post-operative infection, anemia, blood transfusions, incision and drainage and implant removal at 90 days post-operatively (p<0.0001). Within one year, malnutrition was significantly associated with increased malunion, non-union, amputation and implant related complications such infections, implant removal and irritation and debridement (p<0.05). Comparisons for pilon fracture patients were the same in addition to higher rates of wound complications (p<0.001) in malnourished patients.
CONCLUSION: Patients with malnutrition undergoing surgical fixation for ankle and pilon fractures experienced significantly higher rates of systemic complications and adverse surgical outcomes including infections, nonunion and all-cause return to the OR for staged removal of hardware, debridements, arthrodesis, and amputation. These findings should direct postoperative risk management and motivate study into interventions aimed at promoting nutrition and preventing complications in this at-risk population.
