2025 AOFAS Annual Meeting-Paper Session 3A

Video Transcription

Video Summary

This session presented four studies addressing ankle fractures in geriatric and complex patient populations. Dr. Rachit Sagar analyzed over 14,000 elderly patients, showing severe frailty—measured by a five-factor modified frailty index—predicts a fourfold increased 30-day mortality after ankle fracture surgery, along with higher complication and readmission rates. This quick, validated tool may help risk stratify patients to guide operative versus nonoperative management.<br /><br />Dr. Junaid Amir introduced medial malleolar "medial wall blowout" fractures—a complex subtype involving fragmentation above the medial malleolus identified on CT scans. Classifying these into three types, his retrospective study revealed a high rate of posterior tibialis tendon entrapment (~50%) especially in combined fragment types, which significantly raised malreduction risk. The findings emphasize careful tendon assessment and fixation strategies, including possible plating.<br /><br />Medical student Cassandra D’Amico’s work studied ankle ORIF outcomes in patients with preexisting dementia, revealing significantly increased 90-day and longer-term risks of mortality, readmissions, sepsis, and urinary complications. These findings highlight the need for enhanced preoperative cognitive screening, optimization, and postoperative care planning in this vulnerable group.<br /><br />Finally, Mike Levity examined GLP-1 medications in diabetic patients, finding an association with reduced ankle fracture risk despite concerns over nutrition and muscle mass loss. Basic science supports positive effects on bone metabolism, though further research is needed on long-term impacts.<br /><br />Overall, these studies underscore the importance of frailty, cognitive status, detailed fracture morphology, and metabolic factors in guiding ankle fracture treatment and improving outcomes in complex patients.

Keywords

ankle fractures

geriatric patients

frailty index

medial malleolar fractures

posterior tibialis tendon entrapment

dementia and surgery outcomes

ankle ORIF

GLP-1 medications

bone metabolism