Functional Outcomes in Young and Elderly Patients with Trimalleolar Ankle Fractures Treated with open reduction internal fixation: A Retrospective Cohort Analysis

Purpose To evaluate and compare functional outcomes in young and elderly patients with trimalleolar ankle fractures treated surgically with open reduction internal fixations. A secondary objective is to determine whether there is a significant increase in early and late complications, as well as in the need for surgical reinterventions, between the two age groups. Methods A retrospective cohort study was conducted including 103 adult patients with trimalleolar ankle fractures treated surgically with open reduction internal fixations at a single tertiary care center between April 2014 and July 2023. Patients were stratified into two age groups: <65 years (n = 68) and ≥ 65 years (n = 35). Functional outcomes were evaluated 12 months postoperatively using the AOFAS Ankle-Hindfoot Score, the Foot and Ankle Ability Measure (FAAM), and a subjective functional status classification. Complications and reoperations were recorded. Statistical analysis included t-tests, chi-square tests, and linear regression models. Results At a mean follow-up of 16 months, early complications occurred in 7.7% of patients, late complications in 5.8%, and reoperations in 5.8%, with no significant differences between age groups. FAAM% decreased by 2.3 points per decade of age (p = 0.01), while other functional scores did not show age-related differences. Advanced age was not associated with increased complication or reintervention rates. Conclusion Surgically with open reduction internal fixations is a safe and effective treatment for trimalleolar ankle fractures in both younger and older adults. Age-related functional decline does not appear to be surgery-related. Surgical management is appropriate regardless of patient age.