Background: As surgical treatment with open reduction and internal fixation (ORIF) becomes more common, attention to preoperative risk stratification has grown. Although multiple modifiable risk factors and comorbidities have been associated with adverse outcomes, the impact of preexisting decubitus heel ulcers in this context remains yet to be defined.
Methods: Using a nationally representative multi-institutional database, a retrospective analysis was conducted on adults undergoing ORIF for rotational ankle fractures between 2010 and 2022. Patients with a documented decubitus heel ulcer within 4 weeks before surgery were compared with ulcer-free controls. After applying strict exclusion criteria and employing 1:1 propensity score matching for key demographic and clinical variables, 90-day medical complications and 1- and 3-year surgical outcomes were evaluated.
Results: The presence of a preoperative heel ulcer was associated with markedly higher risks of 90-day surgical site infection, sepsis, pneumonia, urinary tract infection, mortality, and deep infection (all P < 0.005). At 1 and 3 years postoperatively, the ulcer cohort demonstrated markedly elevated rates of nonunion, revision surgery, and below-knee amputation (all P < 0.0125).
Conclusions: Preoperative decubitus heel ulceration is associated with elevated risks of both short-term complications and long-term surgical failure following ORIF for ankle fractures. These findings underscore the importance of thorough preoperative foot assessment and may inform surgical planning and perioperative management in this high-risk population.
Level of evidence: Therapeutic Level III, Retrospective Cohort Study.
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