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Mother is 82-years old and lives in Podunk, USA. Yesterday, she broke her ankle tripping over the cat. Now she needs surgery. We want her to come here where there is a large hospital for the surgery. She insists her local orthopedic surgeon will do just fine. Is there any way we can convince her a bigger city-hospital would be better than a small, rural center?

With any surgical procedure, there's always a risk of infection, delayed wound healing, or blood clots. In the case of orthopedic surgery, patients have the additional risk of potential complications during or following each specific operation. With severe ankle fractures, there's the added risk of malunion (fracture heals in poor alignment), nonunion (fracture doesn't heal at all), or the need for revision surgery. Patient risk factors that can affect the results of surgery for ankle fractures include age over 75, severe fracture (more than one bone is broken), and general health. Older adults with diabetes and/or peripheral vascular disease (poor circulation) have a greater chance of developing complications after surgery. It's the job of every physician to assess patients for risk factors that predict future outcomes. Doing so helps doctors guide patients in the direction of reducing those risks and preventing future problems. Studies comparing high-volume hospitals/surgeons versus low-volume don't show a significant difference in results for the treatment of ankle fractures requiring surgery. These kinds of hospital-related factors have been shown in other studies to affect outcomes of hip and knee replacement surgeries. But provider volume hasn't been shown to be a factor in the success or failure of surgery for ankle fractures. The biggest concern for your mother may be postoperative care. Having the support and assistance of family members is in her best interest for a positive outcome with the fewest problems possible.

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