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Using the STTGMA Risk Stratification Tool to Predict Complications, Additional Operations, and Functional Outcomes after Ankle Fracture.

OBJECTIVES
To determine the usefulness of a validated trauma triage score to stratify post-discharge complications, secondary procedures, and functional outcomes after ankle fracture.


DESIGN
Retrospective cohort SETTING:: Level 1 trauma center PATIENTS:: Four hundred and fifteen patients ≥55 years old with 431 ankle fractures INTERVENTION:: Closed or open reduction MAIN OUTCOME MEASUREMENTS:: Score for Trauma Triage in Geriatric and Middle-Aged Patients (STTGMA), post-discharge complications, secondary operations, Foot Function Index (FFI, n=167) and Short Musculoskeletal Function Assessment (SMFA, n=165).


RESULTS
Mean age was 66 years, 38% were male, and 68% of fractures were secondary to ground level falls. Forty patients (9.6%) required an additional procedure, with implant removal most common (n=21, 5.1%), and 102 (25%) experienced a post-discharge complication. On multiple linear regression, STTGMA was not a significant independent predictor of complications or secondary procedures. Patients completed FFI and SMFA surveys a median 62 months (5.2 years) after injury. On the FFI, low-risk STTGMA stratification was an independent predictor of worse functional outcomes. Similarly, low-risk stratification was a predictor of worse scores on the SMFA dysfunction and daily activity subcategories (both B>10, p<0.05).


CONCLUSIONS
Low-risk STTGMA stratification predicted worse long-term function. The STTGMA tool was not able to meaningfully stratify risk for post-discharge complications and secondary procedures following ankle fracture.


LEVEL OF EVIDENCE
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.