Internal Fixation Of Ankle Fractures Research Articles

A Perioperative Prospective Study of WALANT in Open Reduction Internal Fixation of Ankle Fractures: A Malaysian Experience

A Perioperative Prospective Study of WALANT in Open Reduction Internal Fixation of Ankle Fractures: A Malaysian Experience

ROLE OF POSTOPERATIVE CT SCAN IN ASSESSING SYNDESMOTIC REDUCTION IN ANKLE INJURIES

Background: Accurate syndesmotic reduction is necessary for achieving joint congruity and better functional outcomes. Radiographs alone don’t suffice, and CT scans are required for the evaluation of postoperative syndesmotic reduction. Methods: All patients who underwent ankle syndesmotic reduction and fixation from December 2019 to July 2021 were taken into the study. Predefined measurements were taken in postoperative radiographs and axial CT images were taken postoperatively. Sensitivity and specificity of X-rays when compared to CT scan were evaluated. Results: Twenty eight patients were included in the study and 13 cases were found to have syndesmotic malreduction in radiographs as per TCS and TFO in AP view and TFO and MCS measurements in mortise view. Five out of 28 cases were found to have syndesmotic malreduction in CT axial cuts as per standard anterior and posterior measurements. Hence 17.85% cases were malreduced in our study as per the gold standard (CT scan). The incidence of syndesmotic malreduction after fixation was 17.85%. Radiographs had a sensitivity of 60% and specificity of 56.5% in detecting malreduction. Conclusion: CT scan is necessary to accurately diagnose syndesmotic malreduction after open reduction and internal fixation of ankle fractures with associated syndesmotic injuries.

Comparing the risk of reoperation between pneumatic tourniquet and non-tourniquet use in surgical treatment of ankle fractures.

Pneumatic tourniquets are often used during the surgical treatment of unstable traumatic ankle fractures. The aim of this study was to assess the risk of reoperation after open reduction and internal fixation of ankle fractures with and without the use of pneumatic tourniquets. This was a population-based cohort study using data from the Danish Fracture Database with a follow-up period of 24 months. Data were linked to the Danish National Patient Registry to ensure complete information regarding reoperations due to complications, which were divided into major and minor. The relative risk of reoperations for the tourniquet group compared with the non-tourniquet group was estimated using Cox proportional hazards modelling. A total of 4,050 ankle fractures treated with open reduction and internal fixation between 15 March 2012 and 31 December 2016 were included, with 669 (16.5%) undergoing surgery with a tourniquet and 3,381 (83.5%) without a tourniquet. The overall reoperation risk was 28.2% with an adjusted relative risk of 1.46 (95% CI 0.91 to 2.32) for group comparison. The reoperation risk due to major complications was 3.1% with a tourniquet and 4.4% without a tourniquet, resulting in an adjusted relative risk of 1.45 (95% CI 0.91 to 2.32). For minor complications, there were 24.7% and 23.9% reoperations, resulting in an adjusted relative risk of 0.99 (95% CI 0.84 to 1.17). We found no significant difference in the reoperation rate when comparing ankle fractures treated surgically with and without the use of pneumatic tourniquets.

Critical Portions of a Foot or Ankle Surgical Procedure From Patient and Surgeon Perspectives.

Over the past decade, overlapping procedures in orthopaedic surgery have come under increased public scrutiny. Central to this discussion is what should constitute a "critical portion" of any surgical procedure-a definition which may differ between patients and surgeons. This study therefore aimed to assess which components of three common foot and ankle procedures are considered "critical" from both the patient and surgeon perspectives. For this survey-based study, questionnaires were administered to patients who presented to an orthopaedic foot and ankle clinic and separately administered to foot and ankle surgeons through e-mail. The questionnaires broached all steps involved in three common foot and ankle procedures: open reduction and internal fixation of ankle fracture, Achilles tendon repair, and ankle arthroscopy. Respondents were asked to characterize each step as "always critical," "often critical," sometimes critical," rarely critical," or "never critical." A combined "always critical" and "often critical" response rate of greater than 50% was used to define a step as genuinely critical. Patient and surgeon responses were thereafter compared using Mann-Whitney U and Kruskal-Wallis tests ( P -value <0.05 was considered significant). Notably, both patients and surgeons considered informed consent, preoperative marking of the surgical site, preoperative time-out, surgical soft-tissue dissection, and certain procedure-specific steps (critical portions) of these procedures. By contrast, only patients considered skin incision and wound closure to be critical steps. Patients and surgeons were largely in agreement as to what should comprise the critical portions of several common foot and ankle procedures. Certain discrepancies did exist, however, such as skin incision and closure, and both groups were also in general agreement regarding what was not considered a critical component of these operations. Such findings highlight a potential opportunity for improved preoperative patient education and patient-physician communication. Level IV: Evidence from well-designed case-control or cohort studies.

Effect of Distal Tibiofibular Destabilization and Syndesmosis Compression on the Flexibility Kinematics of the Ankle Bones: An In Vitro Human Cadaveric Model.

Overcompression of the distal tibiofibular syndesmosis during open reduction and internal fixation of ankle fracture may affect multidirectional flexibility of the ankle bones. Ten cadaveric lower limbs (78.3±13.0 years, 4 female, 6 male) underwent biomechanical testing in sagittal, coronal, and axial rotation with degrees of motion quantified. The intact force (100%) was the force needed to compress the syndesmosis just beyond the intact position, and overcompression was defined as 150% of the intact force. After intact testing, the anterior inferior tibiofibular ligament (AITFL), interosseus membrane (IOM), and posterior inferior tibiofibular ligament (PITFL) were sectioned and testing was repeated. The IOM and AITFL were reconstructed in sequence and tested at 100% and 150% compression. Overcompression of the syndesmosis did not significantly reduce ROM of the ankle bones for any loading modality (P > .05). IOM+AITFL reconstruction restored distal tibiofibular axial rotation to the intact condition. Axial rotation motion was significantly lower with AITFL fixation compared with IOM fixation alone (P < .05). The proximal tibiofibular syndesmosis demonstrated significantly higher motion in axial rotation with all distal reconstruction conditions. As assessed by direct visualization, overcompression of the distal tibiofibular syndesmosis did not reduce ROM of the ankle bones. Distal tibiofibular axial rotation was significantly lower with IOM+AITFL fixation compared with IOM augmentation alone. Distal tibiofibular axial rotation did not differ significantly from the intact condition after combined IOM+AITFL fixation. Dynamic fixation of the distal tibiofibular syndesmosis resulted in increased axial rotation at the proximal tibiofibular syndesmosis. These biomechanical data suggest that inadvertent overcompression of the distal tibiofibular syndesmosis when fixing ankle fractures does not restrict subsequent ankle bone ROM. The AITFL is an important stabilizer of the distal tibiofibular syndesmosis in external rotation. controlled laboratory study.

Immediate Unprotected Weightbearing vs 2 Weeks Nonweightbearing After Open Reduction Internal Fixation of Ankle Fractures.

Postoperative care protocols for ankle fracture surgery remain controversial with variability among care providers. This prospective controlled trial compared 12-week postoperative outcomes for immediate unprotected weightbearing (IMWB) vs nonweightbearing (NWB) for 2 weeks in a splint followed by weightbearing as tolerated (WBAT) in a boot after surgical fixation of selected low-energy ankle fractures without superior articular involvement. Eighty-seven patients undergoing surgical fixation of ankle fractures at a single level 1 trauma center were recruited according to specific criteria and enrolled by presentation date. The first 43 eligible patients were allocated to the control group, with NWB in a splint for 2 weeks followed by WBAT in a walker boot. The next 44 patients recruited were allocated to the IMWB group. The primary outcome was the Olerud-Molander score (OMAS). Secondary outcome measures included the Euroquol-5D (EQ5D) score and Work Productivity and Activity Impairment: Specific Health Problem (WPAI:SHP) scores, ankle range of motion (ROM), wound complications, time to return to work, radiograph measurements, and fracture reduction loss. In this perioperative-focused study, we collected data on patients until 12 weeks postoperation. The IMWB group had 5 superficial wound complications vs 1 in the control group. At 12 weeks, we found no difference in OMAS, EQ5D, WPAI:SHP scores, ROM, time to return to work, or radiographic measurements. In this short-term and relatively small prospective trial, we found more wound complications among patients treated with immediate unprotected weightbearing compared with patients treated with 2 weeks of NWB followed by protected weightbearing. Given the low incidence and small sample size, we do not know if these observed findings are generalizable. However, we also found no difference in functional outcomes at 12 weeks postoperation between these 2 groups. In light of that, we do not recommend IMWB after open reduction internal fixation of low-energy ankle fractures with plate and/or screw fixation. Level II, prospective controlled trial.

Retracted: Clinical Application of Graphene Composite in Internal Fixation of Ankle Fracture in Sports

Retracted: Clinical Application of Graphene Composite in Internal Fixation of Ankle Fracture in Sports

Wound complication risk factors following open reduction and internal fixation of ankle fractures.

This study was designed to identify risk factors for wound complications including surgical site infection (SSI) and wound healing issues following open reduction and internal fixation (ORIF) of ankle fractures. A retrospective analysis of individuals with ankle fractures treated with ORIF was undertaken. Study subjects were divided into a wound complications (WC) group and a no wound complication (NWC) group. The WC group was further divided into an SSI group and wound healing issues group. Twenty-one potential risk factors associated with wound complications after ORIF were tracked. Uni- and multivariate binary logistical regression analyses were used to identify risk factors associated with wound complications, ISS and wound healing issues. In total, 613 individuals, who had undergone surgery for ankle fractures formed the study cohort. The incidence of postoperative wound complications was 10.3% (63 cases), including 5.2% of SSI (32 cases) and 5.1% of wound healing issues (31 cases). The independent risk factors for wound complications were age 65 years or older, preoperative serum albumin level below 35 g/L, peripheral neuropathy, open fracture, fewer than seven cases per year in surgical volume, and attending surgeon level. The independent risk factors for SSI were age 65 years or older, preoperative serum albumin level below 35 g/L, open fracture and fewer than seven cases per year in surgical volume. The independent risk factors for wound healing issues were preoperative serum albumin level below 35 g/L, peripheral neuropathy, open fracture and attending surgeon level. Herein we found both factors inherent to the injury and individual and those pertaining to the surgical team affected the frequency of wound complications after ORIF of ankle fractures. Specifically, advanced age and low surgical volume were associated with a greater risk of SSI. Peripheral neuropathy and the low expertise level on the part of the surgeon were associated with a greater risk of wound healing issues. Hypoproteinaemia and open fracture were both associated with a greater risk of both SSI and wound healing issues.

Anemia and Its Severity Is Associated With Worse Postoperative Outcomes Following Open Reduction Internal Fixation of Ankle Fractures.

Ankle fractures are often treated in a nonemergent fashion and therefore offer the chance for treatment of preoperative anemia. Although preoperative anemia has been associated with postoperative morbidity following certain types of orthopaedic procedures, its effect on postoperative outcomes following open reduction internal fixation (ORIF) of ankle fractures has not been evaluated. The purpose of this study was to determine the influence of preoperative anemia on 30-day postoperative outcomes following ankle fracture ORIF. The American College of Surgeons National Surgical Quality Improvement Program (ASC-NSQIP) registry was queried from 2005 to 2019 for patients undergoing ankle fracture ORIF. Patients were stratified into nonanemic, mildly anemic, and moderately to severely anemic. Univariate analyses were used to assess differences in patient characteristics between cohorts. Multivariate logistic regressions adjusting for these differences were performed to assess the effect of preoperative anemia on 30-day postoperative outcomes. We obtained data for 21 211 patients, of whom 14 931 (70.39%) were not anemic, 3982 (18.77%) were mildly anemic, and 2298 (10.83%) were moderately to severely anemic. After adjustment, mild preoperative anemia was associated with higher odds of any adverse event (P < .001), deep surgical site infections (SSIs; P = .013), sepsis (P = .001), 30-day readmission (P < .001), and extended length of stay (LOS) (P < .001). Similarly, moderate to severe anemia in these patients was also associated with increased odds of any adverse event (P < .001), deep SSIs (P = .003), sepsis (P = .001), readmission (P < .001), and extended LOS (P < .001). Both mild (P = .004) and moderate to severe (P < .001) anemia groups had higher odds of requiring a blood transfusion. Preoperative anemia is associated with an increased risk of adverse postoperative outcomes in patients undergoing ORIF for ankle fractures. Future studies should evaluate whether optimization of hematocrit in these patients results in improved outcomes. Level III, comparative study.

Presence of Anemia and Its Severity is Associated with Worse Outcomes Following Open Reduction Internal Fixation of Ankle Fractures

Category: Trauma; Ankle Introduction/Purpose: Preoperative anemia has been associated with significant postoperative morbidity following various types of orthopaedic procedures. However, to our knowledge, there is no study assessing postoperative outcomes following open reduction internal fixation (ORIF) of ankle fractures with varying severity of anemia. The purpose of this study was to determine the influence of preoperative anemia severity on 30-day postoperative outcomes following ankle fracture ORIF. Methods: The American College of Surgeons National Surgical Quality Improvement Program registry was queried from 2005 to 2019 for patients undergoing ankle fracture ORIF. Patients were stratified into 3 cohorts: non-anemic (hematocrit &gt; 36% for women, &gt;39% for men), mildly anemic (hematocrit 33%-36% for women, 33%-39% for men), and moderately to severely anemic (hematocrit &lt;33% for both women and men) based on World Health Organization definitions. Patients with missing hematocrit data were excluded. Univariate analyses were utilized to assess differences in patient characteristics between cohorts. Multivariate logistic regressions controlling for differences between subgroups were performed to assess the effect of preoperative anemia on 30-day postoperative outcomes. Statistical significance was set at P&lt;0.05. Results: In total, 22,413 patients that underwent ORIF for ankle fractures were included. Of these, 15,739 (70.22%) were not anemic, while 4,243 (18.93%) and 2,431 (10.85%) were mildly and moderately to severely anemic, respectively. Multivariate analysis revealed that mild preoperative anemia in patients undergoing ankle fracture ORIF was associated with higher odds of any adverse event (OR 1.62, P&lt;0.001), superficial surgical site infections (SSIs) (OR 1.46, P=0.047), deep SSIs (OR 2.06, P=0.022), sepsis (OR 2.83, P=0.002), 30-day readmission (OR 1.61, P&lt;0.001), and extended length of stay (LOS) (OR 1.56, P&lt;0.001). Similarly, moderate to severe anemia in these patients was also associated with increased odds of any adverse event (OR 1.94, P&lt;0.001), deep SSIs (OR 2.77, P=0.006), sepsis (OR 3.55, P=0.001), readmission (OR 2.07, P&lt;0.001), and extended LOS (OR 2.21, P&lt;0.001). In addition, moderate to severe anemia patients were associated with higher odds of unplanned reoperation (OR 2.31, P&lt;0.001) and progressive renal insufficiency (OR 3.74, P=0.048). Conclusion: Preoperative anemia is associated with an increased risk of adverse postoperative outcomes in patients undergoing ORIF for ankle fractures. This association seems to be dose dependent, as the odds of adverse events increases with increases in anemia severity. Medical optimization of patients with moderate to severe anemia should take precedence.

A Prospective Evaluation of Opioid Utilization Following Ankle Fracture Surgery

Category: Trauma; Ankle Introduction/Purpose: There has been significant scrutiny of physicians' opioid prescribing patterns for both operative and non- operative patients. Orthopaedic surgeons are the third highest group of opioid prescribers among physicians in the United States. The wide scope of orthopaedic procedures lends to the variability and difficulty in setting forth prescribing guidelines. Recent orthopedic literature has highlighted that orthopaedic surgeons are prescribing excess narcotic medication than is needed in common orthopaedic procedures. Ankle fractures make up about 9% of all fractures, which correlates to about 400,000 per year. The purpose of this study was to assess the amount of post-operative pain medication being prescribed and how much of that medication was being consumed in patients who underwent an open reduction internal fixation (ORIF) of an ankle fracture. Methods: We identified all patients that underwent a unilateral ORIF of a closed ankle fracture. We prospectively collected data on patients at the time of surgery. Patients were identified and enrolled in the study prior to their surgical procedure, where they were instructed to bring their pain medication bottle with them to their first post-operative visit. Patients were asked about the quantity of opioids consumed. At the twelve-week post-op, the American Orthopedic Foot and Ankle Score (AOFAS) was completed by the patient. We recorded the number, dosage, and formulation of opioid medication prescribed up to 90 days after surgery using the Pennsylvania Drug Monitoring Program (PDMP) website. Using opioid equianalgesic charts, we converted dosages of opioid to a morphine milligram equivalent (MEq) to standardize prescription amounts across all patients. Descriptive statistics were calculated and reported. Categorical data were compared using chi-square tests and quantitative data were compared using independent sample t-tests. Results: 75 patients were included in our study, 45 of which were female. The mean age of the patient was 46.7 years old with a range from 17-77 years old. On average, 400MEq were prescribed to the patient after surgery. Patients consumed an average of 258 MEq within the 2 weeks following surgery, which accounted for about 65% of the initial prescription. Thirty (13.3%) patients consumed their entire first prescription. Patients who consumed the full opioid prescription were 8.7 times more likely (95% CI 2.6, 29.3, X2(1)=14.1, p&lt;0.001) to have other scripts filled in the PDMP. After adjusting for inequal variances, an independent samples t-test found that subjects that did not consume the full prescription also had statistically significantly higher functionality scores (82 vs. 70) than patients that consumed the full prescribed amount (p=0.001). Conclusion: We found the average patient consumes the equivalent of 34 pills of 5mg oxycodone after undergoing an open reduction internal fixation of an ankle fracture. Our providers over prescribed, on average, by 21 total pills. 9.3% of patients were still requiring narcotic pain medication ninety days post-operatively. Those patients who did not consume their first narcotic prescription were found to have statistically better functional outcome scores compared to those who did. Further studies should continue to assess patient characteristics, surgeon techniques, and prescribing habits to further improve post-operative pain control in patients undergoing open reduction internal fixation of ankle fractures.

Clinical Application of Graphene Composite in Internal Fixation of Ankle Fracture in Sports

The ankle joint consists of the tibia, the fibrous lower end, and the talus. Osteoporotic fractures and deboning are common injuries in orthopaedic surgery, often due to abnormal disorders following an ankle fracture. Various fractures can occur depending on the shape, size, and position of the foot at the time of the injury. With the continuous development of science and the continuous improvement of modern sports level, scientists and sports workers worldwide recognize the importance of applying new materials in sports equipment. Composite material is a combination of multiphase combination material. In short, two or more components with different properties and different forms are used in a multimaterial combination of composite means. The organic combination of related scientific equipment and composite materials promotes the development of sports equipment and the probability of reducing sports injury. The function of the existing graphene composite is analyzed and applied, and the combination of graphene composite and sports is realized theoretically. The clinical application of graphene composite in sports is studied to promote sports development. This article mainly studies the clinical application of graphene composite in ankle fracture internal fixation in sports. It is found that with the increasingly mature application of graphene rubber composite, graphene fiber composite, and other graphene composite materials, it can be widely used in all aspects of sports equipment. Graphene composite materials can be used more easily in sports equipment. In this article, the thermal material conversion algorithm, Schrodinger equation in quantum mechanics, and the use method of graphene composite materials are used to study the clinical application of graphene composite in the internal fixation of ankle joint fracture in sports. The frequent injury and instability of ankle and knee joints are signs of ankle and knee joint injury. The main factors that affect the instability of ankle and knee function are the comprehensive effects of motion range, muscle force valgus, and body feeling, and graphene composite materials are widely used in the internal fixation of ankle joint fracture in sports. The results show that graphene composite can be used in sports equipment and has a great space and high feasibility through the analysis of four groups of sports equipment. It shows that advanced materials play a very important role in the research of sports equipment.

Weight-bearing Allowed Following Internal Fixation of Ankle Fractures, a Systematic Literature Review and Meta-Analysis.

Postoperative management regimes vary following open reduction and internal fixation of unstable ankle fractures. Traditional postoperative nonweightbearing cast immobilization may prevent loss of fixation and protect the soft tissue envelope but may also be associated with poorer functional outcomes. This systematic review and meta-analysis aimed to compare the complication rate and functional outcomes of early weightbearing (EWB) vs late weightbearing (LWB) following open reduction and internal fixation of ankle fractures. We performed a systematic review with a meta-analysis of controlled trials and comparative cohort studies using 3 databases. We included all studies that investigated the effect of weightbearing following internal fixation of ankle fractures in adult patients by any means. Studies that investigated mobilization but not weightbearing, non-English-language publications, and tibial Plafond fractures were excluded from this systematic review. We assessed the risk of bias using ROB 2 tools for randomized controlled trials and ROBINS-1 for cohort studies. Data extraction was performed using Covidence online software and meta-analysis by using RevMan 5.3. This systematic review included 10 randomized controlled trials and 4 comparative cohort studies. Most of the included studies were rated as having some concern with regard to the risk of bias. There was no significant difference in the complication rate between the protected EWB and LWB groups (the risk ratio [RR] for infection was 1.30, 95% CI 0.74, 2.30; I² = 0%; P = .36), but better functional outcome scores were detected in the EWB group only at 6 weeks postoperatively (MD =10.08, 95% CI 5.13, 15.02; I² = 0%; P ≤ .0001), with no significant difference seen at 6 or 12 months postoperatively. Based on the studies reviewed, it appears that early protected weightbearing following open reduction and internal fixation of ankle fractures does not affect surgical incision or fracture healing and is associated with better early functional outcomes at 6 weeks, but not 6 or 12 months, postoperatively.

Ilizarov Ankle Arthrodesis: A Simple Salvage Solution for Failed and Neglected Ankle Fractures.

Infection around theankle joint after fracture fixation, or septic arthritis with active discharging sinuses is often challenging to manage with conventional procedures of arthrodesis. The Ilizarov method of arthrodesis gives a better alternative for salvage in such cases. This was a retrospective study including 20 patients who were subjected to tibiotalar arthrodesis with Ilizarov method. The major pathologies included internal fixation of ankle fractures complicated by infection, posttraumatic infected ankle arthritis, and osteomyelitis. The patients were evaluated on the basis of Association for the Study and Application of the Method of Ilizarov (ASAMI) criteria. The aim of the surgery was to achieve plantigrade, stable, and painless foot with no signs of infection. A total of 20 patients were operated and reviewed at our institute. The study comprised of 15 male and 5 female patients with a mean age of 43.9years (range 33-55years). Out of 20 patients, 4 patients had complications of pin-tract infection and one had wire breakage of the forefoot ring. According to the ASAMI criteria, 17 patients had excellent bone scores and 18 patients had good functional scores. Union was achieved in all patients with resolution of infection and the mean limb length discrepancy was 1.92cm (range 1-2.5cm). The Ilizarov fixator for ankle arthrodesis provides an excellent way for strong bone fusion, infection eradication, early weight-bearing, and the added benefits of compression atthe arthrodesis site post-operatively.

Early Unprotected Weight Bearing and Pre-Scheduled Supervised Rehabilitation Program after Surgical Treatment of Ankle Fractures.

Ankle fractures represent one of the most common orthopedic injuries in the lower extremity. Weight-bearing and rehabilitation protocols after surgical treatment of ankle fracture have recently evolved from traditional methods to full weight-bearing protocols. However, more evidence is needed on unprotected immediate weight-bearing along with a standardized rehabilitation program. The purpose of this study was to evaluate effects of unprotected immediate weight-bearing as tolerated and an eight-week prescheduled supervised rehabilitation program on the mid-term clinical and functional outcomes of surgically treated ankle fractures, and to compare functional results with the unaffected side. Eighty patients (24F and 56M) who underwent rigid fixation of bimalleolar ankle fractures were included (mean age 41.57±13.22 years). Preoperative radiographs and computed tomography scans were used to evaluate and classify the fractures. The fractures were classified using Lauge-Hansen classification system. Ankle ROMs, Pain Disability Index (PDI), American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scores, and Short Form-36 scores were evaluated. Patients were allowed unprotected weight-bearing on the immediate postoperative period and a standardized supervised prescheduled rehabilitation program was undertaken following surgery. The mean follow-up period was 30.32±6.91 months. Based on Lauge-Hansen classification, supination-external rotation injuries were found in 32(40%) patients, supination adduction injuries in 14(17.4%) patients, pronation-external rotation injuries in 28(35%) patients, and pronation-abduction fractures in 6(7.6%) patients. The solid union was achieved in all patients at the final follow-up. The mean PDI score was 12.78±14.78, and the AOFAS score was 80.93±17.24. Although patients' health-related quality of life was at a good level, the injured-side ankle ROM was lower than the healthy side (p ≤ 0.05). Satisfactory clinical and functional outcome can be achieved at mid-term with unprotected weight-bearing as tolerated and pre-scheduled supervised eight-week rehabilitation program following rigid internal fixation of ankle fractures. However, this protocol is not studied in patients with associated comorbidities.

Outcomes Following Open Reduction Internal Fixation of Ankle Fractures (ORIF) By Podiatric Surgeons

Open reduction internal fixation of closed ankle fractures is a common procedure performed by podiatric surgeons. This is the first study to specifically evaluate complication rates of this procedure among podiatric surgeons using a large patient cohort. The rates of podiatric surgical complications were also compared to the complication rates reported in the orthopedic literature. There was no significant difference between podiatric surgeons and orthopedic surgeons with regards to surgical site infection. However, complication rates, including 1-year postsurgery deep vein thrombosis (DVT), malunion, and unplanned revision surgery within 90-day, were lower in our study, compared to the average rates reported in the orthopedic literature. The authors believe that the most important determinant for post ankle surgical complications is related to surgical volume and experience, rather than professional degree type.

Increasing age and modifiable comorbidities are associated with short-term complications after open reduction and internal fixation of ankle fractures.

Ankle fractures are common orthopedic injuries with complication rates fixation of up to 40%. Limited evidence exists in the literature regarding complications in the elderly population, and moreover, these studies frequently define elderly arbitrarily at 60-65years old. The purpose of the present study was to utilize a large, validated database to evaluate whether there is an inflection point of age when postoperative complications after an ankle fracture significantly increase. A retrospective review of all patients in the American College of Surgeons National Surgical Quality Improvement Program database who underwent fixation of an ankle fracture between 2012 and 2018 was performed. Patients were identified within the database using the Current Procedural Terminology codes. Appropriate statistical analysis was performed with p value less than 0.05 considered statistically significant. A total of 27,633 fractures were including and comprised of 221 posterior malleolar, 1567 medial malleolar, 8495 lateral malleolar, 10,175 bimalleolar, and 7175 trimalleolar. A total of 1545 complications were encountered (5.6%). There was a statistically significant association between increasing age and complications (OR = 1.03; p < 0.001). Further analysis shows the largest spike in complications within the age 78 + bracket. There were no overall interaction effects between age and fracture subtype (p = 0.223). ORIF of ankle fractures is a common orthopedic procedure performed on patients of all ages, with complications ranging in severity. In order to best counsel patients on their individual postoperative risks, large datasets are often necessary to prognosticate. This study found that postoperative complications increase with advanced age. The incidence of complications did not spike for patients around the age of 65, but rather followed an incremental linear pattern with the largest increase in odds ratio occurring at age 78 and above. Complication rate was not associated with specific fracture type based off of ICD codes.

Ankle Fracture Fixation with Use of WALANT (Wide Awake Local Anesthesia with No Tourniquet) Technique: An Attractive Alternative for the Austere Environment.

Wide awake local anesthesia with no tourniquet (WALANT) is a simple technique that has had successful application in hand surgery. When utilized in the plating of distal radial fractures, the WALANT technique has proven to be a cost-effective approach in orthopaedic trauma. The aim of the present study was to assess the applicability of the WALANT technique in open reduction and internal fixation of ankle fractures. Fifty-eight patients were recruited from October 2016 to September 2018. Fractures were categorized according to the OTA/AO classification. We did not include patients with Maisonneuve, talar, or posterior malleolar fractures. Mechanism of injury, fracture type, comorbidities, and complications were recorded. The surgical site was infiltrated to achieve local anesthesia using a solution of 0.9% normal saline solution and 2% lidocaine with 1:1,000,000 epinephrine. Functional outcomes were assessed at the time of fracture union with use of the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale. Thirty-nine patients (67%) were male and 19 (33%) were female, and the mean age was 46.79 ± 8.54 years. According to the OTA/AO classification, 36 fractures (62%) were 44C2, 11 (19%) were 44B2, 7 (12%) were 44C1, and 4 (7%) were 44B1 fractures. Average blood loss was 29.40 ± 7.38 mL, the mean operative time was 59.72 ± 7.19 minutes, and the mean intraoperative visual analogue scale (VAS) for pain was 1.24 ± 0.43 (range, 0 to 3). The mean time to union was 16.21 ± 3.52 weeks, with a mean AOFAS Ankle-Hindfoot Scale score of 86.38 ± 5.72. Three patients (5.2%) developed nonunion of a fracture site, 2 patients had a surgical site infection, and 1 noncompliant diabetic patient developed osteomyelitis. The WALANT technique is a safe technique for ankle fracture fixation and has been shown to be useful in foot and ankle surgery, particularly in limited-resource environments. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Functional outcome of surgical management of ankle fractures with syndesmotic injury

Background: Ankle fractures with Syndesmotic injury are common in Orthopaedic practice. Ankle fractures are the second most common significant lower extremity fractures. Syndesmotic ankle injuries disrupt normal joint functioning, hence need meticulous diagnosis and surgical management to prevent crippling disabilities. Objective: To evaluate the functional outcome of surgically managed ankle fractures with Syndesmotic injury using AOFAS score. Materials and Methods: In this study, 40 patients diagnosed as ankle fractures with Syndesmotic injury, underwent Syndesmotic screw fixation using 3.5mm cortical screws in addition to anatomical fixation of medial and lateral malleolus. Functional outcome was analyzed at 6 months using AOFAS score. Results: In this study, 42.5% (17 patients) of patients had excellent outcome, 45% (18 patients) patients had good outcome, 7.5% (3 patients) had fair outcome, while 5% (2 patients) had poor outcome. 2 patients developed superficial wound infection, treated with IV antibiotics. One patient developed non union and one patient with ankle stiffness. Conclusion: For all cases of Ankle fractures with Syndesmotic injury, open reduction and internal fixation of ankle fracture with Syndesmotic screw fixation helped to achieve good union of fractures and pain free, stable ankle joint.

Spinal Anesthesia Associated With Increased Length of Stay Compared to General Anesthesia for Ankle Open Reduction Internal Fixation: A Propensity-Matched Analysis

General and spinal anesthesia are both utilized for patients undergoing open reduction internal fixation of the ankle, but there are little data comparing early complication rates. The purpose of this study was to compare duration of surgery, length of stay, and rates of postoperative adverse events within 30 days in patients undergoing open reduction internal fixation of ankle fracture using spinal versus general anesthesia. Adult patients who underwent open reduction internal fixation of a closed ankle fracture from 2012 to 2016 were retrospectively identified from American College of Surgeons National Surgical Quality Improvement Program. Duration of surgery, length of stay, 30-day adverse events, and unplanned readmissions were compared between patients who received general anesthesia and spinal anesthesia. Propensity adjustment with respect to known risk factors for complications and adjunctive regional block was used to match patients. Of the 10,795 patients included after applying the inclusion and exclusion criteria, 9862 (91.36%) received general anesthesia and 933 (8.64%) received spinal anesthesia. Using propensity-scored matching, 841 patients in the spinal cohort were matched to 3364 patients in the general cohort. Spinal anesthesia was associated with increased length of stay (+0.5 days, 95% confidence interval 0.23-0.77, p < .001). There were no differences in the rates of major/minor complications, mortality, transfusions, unplanned readmissions, or duration of surgery. General anesthesia is predominantly used for fixation of ankle fractures. While spinal anesthesia is associated with lower complication rates in hip and knee surgery, we found that it is associated with increased length of stay in patients undergoing open reduction internal fixation of the ankle within 30 days of surgery.