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Baxter S, Johnson AH, Brennan JC, Rana P, Friedmann E, Spirt A, Turcotte JJ, Keblish D. Inpatient or Outpatient: Does Initial Disposition Affect Outcomes in Trimalleolar Ankle Fractures? Cureus 2024; 16:e59586. [PMID: 38826959 PMCID: PMC11144383 DOI: 10.7759/cureus.59586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2024] [Indexed: 06/04/2024] Open
Abstract
Background The repair of trimalleolar fractures can be challenging for surgeons and may be managed as an inpatient or an outpatient. However, it is often unclear whether these patients should be admitted immediately or sent home from the emergency department (ED). This study aims to evaluate trimalleolar fractures treated surgically in the inpatient or outpatient settings to evaluate differences in outcomes for these patients. Methods A retrospective chart review of 223 patients undergoing open reduction internal fixation of a trimalleolar ankle fracture was performed from January 2015 to August 2022. Patients were classified by whether the fixation was performed as an inpatient or outpatient. Outcomes of interest included time from injury to surgery, complications, ED returns, and readmissions within 90 days. Results Inpatients had significantly higher ASA scores, BMI, and rates of comorbidities. Inpatient treatment was associated with faster time to surgery (median 2.0 vs. 9.0 days) and fewer delayed surgeries more than seven days from injury (18.4 vs. 67.9%). There were no differences in complications, 90-day ED returns, readmissions, or reoperation between groups. Conclusions Inpatient admission of patients presenting with trimalleolar ankle fractures resulted in faster time to surgery and fewer surgical delays than outpatient surgery. Despite having more preoperative risk factors, inpatients experienced similar postoperative outcomes as patients discharged home to return for outpatient surgery. Less restrictive admission criteria may improve the patient experience by providing more patients with support and pain control in the hospital setting while decreasing the time to surgery.
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Affiliation(s)
- Samantha Baxter
- Orthopedic Research, Anne Arundel Medical Center, Annapolis, USA
| | | | - Jane C Brennan
- Orthopedic Research, Anne Arundel Medical Center, Annapolis, USA
| | - Parimal Rana
- Orthopedic Research, Anne Arundel Medical Center, Annapolis, USA
| | | | - Adrienne Spirt
- Orthopedic Surgery, Anne Arundel Medical Center, Annapolis, USA
| | - Justin J Turcotte
- Orthopedic and Surgical Research, Anne Arundel Medical Center, Annapolis, USA
| | - David Keblish
- Orthopedic Surgery, Anne Arundel Medical Center, Annapolis, USA
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[Translated article] Position statement relating ankle fractures in major outpatient surgery. Rev Esp Cir Ortop Traumatol (Engl Ed) 2022. [DOI: 10.1016/j.recot.2021.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Documento de posicionamiento respecto a las fracturas de tobillo en cirugía mayor ambulatoria. Rev Esp Cir Ortop Traumatol (Engl Ed) 2022; 66:229-234. [DOI: 10.1016/j.recot.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 12/28/2021] [Accepted: 12/29/2021] [Indexed: 10/18/2022] Open
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Malik AT, Quatman CE, Khan SN, Phieffer LS, Rao P, Ly TV. Outpatient Versus Inpatient Surgical Fixation of Isolated Ankle Fractures: An Analysis of 90-Day Complications, Readmissions, and Costs. J Foot Ankle Surg 2021; 59:502-506. [PMID: 31685364 DOI: 10.1053/j.jfas.2019.09.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 08/15/2019] [Accepted: 09/26/2019] [Indexed: 02/03/2023]
Abstract
Despite increasing interest toward managing isolated ankle fractures in an outpatient setting, evidence of its safety remains largely limited. The 2007 to 2014 Humana Administrative Claims database was queried to identify patients undergoing open reduction internal fixation for unimalleolar, bimalleolar, or trimalleolar isolated closed ankle fractures. Two cohorts (outpatient versus inpatient) were then matched on the basis of age, sex, race, region, fracture type (uni-/bi-/trimalleolar) and Elixhauser Comorbidity Index to control for selection bias. Multivariate regression analyses were performed to report independent impact of outpatient-treated ankle fracture surgery on 90-day complications, readmission, and emergency department visit rates. Independent-samples t test was used to compare global 90-day costs between cohorts. A total of 5317 inpatient-treated and 6941 outpatient-treated closed ankle fractures were included in the final cohort. After matching and multivariate analyses, patients with outpatient ankle fractures, compared with patients with inpatient ankle fractures, had statistically lower rates of pneumonia (2.3% versus 4.0%; p < .001), myocardial infarction (0.9% versus 1.8%; p = .005), acute renal failure (2.2% versus 5.3%; p < .001), urinary tract infections (7.4% versus 12.3%; p < .001), and pressure ulcers (0.9% versus 2.0%; p = .001). Outpatient ankle fractures also had lower rates of 90-day readmissions (9.7% versus 14.1%; p < .001) and emergency department visits (13.8% versus 16.2%; p = .028). Last, overall 90-day costs for outpatient ankle fractures were nearly $9000 lower than costs for inpatient ankle fractures ($12,923 versus $21,866; p < .001). Based on our findings, it appears that outpatient treatment of ankle fractures can be deemed safe and feasible in a select cohort of patients.
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Affiliation(s)
- Azeem Tariq Malik
- Research Fellow, Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Carmen E Quatman
- Assistant Professor, Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Safdar N Khan
- Associate Professor, Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Laura S Phieffer
- Associate Professor, Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Prakruti Rao
- Research Coordinator, Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Thuan V Ly
- Associate Professor, Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH.
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Wolfstadt JI, Wayment L, Koyle MA, Backstein DJ, Ward SE. The Development of a Standardized Pathway for Outpatient Ambulatory Fracture Surgery: To Admit or Not to Admit. J Bone Joint Surg Am 2020; 102:110-118. [PMID: 31644523 DOI: 10.2106/jbjs.19.00634] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Increased scrutiny of health-care costs and inpatient length of stay has resulted in many orthopaedic procedures transitioning to outpatient settings. Recent studies have supported the safety and efficiency of outpatient fracture procedures. The aim of the present study was to reduce unnecessary inpatient hospitalizations for healthy patients awaiting surgical treatment of a fracture by 80% by June 30, 2017, with a focus on timely, efficient, and patient-centered care. METHODS The study design was a time series using statistical process control methodology. Baseline data from October 2014 to June 2016 were compared with the intervention period from July 2016 to December 2018. The Model for Improvement was used as the framework for developing and implementing interventions. The main interventions were a policy change to allow booking of outpatient urgent-room cases, education for patients and nurses, and the development of a standardized outpatient pathway. RESULTS One hundred and eighty-seven patients during the pre-intervention period and 308 patients during the intervention period were eligible for the ambulatory pathway. The percentage of patients managed as outpatients increased from 1.6% pre-intervention to 89.1% post-intervention. The length of stay was reduced from 2.8 to 0.2 days, a decrease of 94.0%. Patient satisfaction remained high, and there were no safety concerns while patients waited at home for the surgical procedure. CONCLUSIONS The outpatient fracture pathway vastly improved the efficiency and timeliness of care and reduced health-care costs. A patient-centered culture and support from hospital administration were integral in producing sustainable improvement. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Jesse I Wolfstadt
- Granovsky Gluskin Division of Orthopaedics, Sinai Health System, University of Toronto, Toronto, Ontario, Canada
| | - Lisa Wayment
- Granovsky Gluskin Division of Orthopaedics, Sinai Health System, University of Toronto, Toronto, Ontario, Canada
| | - Martin A Koyle
- Division of Urology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - David J Backstein
- Granovsky Gluskin Division of Orthopaedics, Sinai Health System, University of Toronto, Toronto, Ontario, Canada
| | - Sarah E Ward
- Division of Orthopaedics, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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Cost Comparison of Surgically Treated Ankle Fractures Managed in an Inpatient Versus Outpatient Setting. J Am Acad Orthop Surg 2019; 27:e127-e134. [PMID: 30192248 DOI: 10.5435/jaaos-d-16-00897] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Although choices physicians make profoundly affect the cost of health care, few surgeons know relative costs associated with the setting in which care is provided. Without valid cost information, surgeons cannot understand how their choices affect the total cost of care. METHODS Actual costs for all isolated, surgically treated ankle fractures at a level I trauma hospital and affiliated outpatient surgery center were determined using a validated episode of care costing system and analyzed using multivariate regression analysis in this retrospective cohort study. RESULTS One hundred forty-eight patients (ie, 61 inpatients and 87 outpatients) with isolated, surgically treated ankle fractures were included. After controlling for confounding variables, outpatient care was associated with 31.6% lower costs compared with inpatient care. Obese patients had 21.6% higher costs compared with patients who were not obese. No difference was noted in revision surgery, readmission, or return visits to the emergency department for patients treated on an inpatient or outpatient basis. CONCLUSION Where medically/socially appropriate, this analysis suggests that ankle fracture surgery should be provided in an outpatient surgical facility to provide the greatest value to the patient and society. LEVEL OF EVIDENCE Level III.
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Abstract
Interest in outpatient orthopedic surgery has been fueled by provider desire to control costs and development of rapid recovery protocols. Open reduction and internal fixation (ORIF) is a commonly elected treatment strategy for ankle fracture that may be performed in an outpatient setting. Lessons on cost-savings of the outpatient model in orthopedics can be learned in total joint replacement and spine surgery. Moreover, in properly selected patients, outpatient ORIF has been shown to be comparably safe. Reasons for admission of the surgically managed patient with ankle fractures, including concern for surgical delay and additional social factors, warrant further investigation.
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Affiliation(s)
- Charles Qin
- Department of Orthopedic Surgery, University of Chicago, 5841 S Maryland Avenue Ste Mc6098, Chicago, IL 60637, USA
| | - Robert G Dekker
- Department of Orthopedic Surgery, Northwestern University, 240 E Huron Street # M300, Chicago, IL 60611, USA
| | - Mia M Helfrich
- Department of Orthopedic Surgery, Northwestern University, 240 E Huron Street # M300, Chicago, IL 60611, USA
| | - Anish R Kadakia
- Foot and Ankle, Foot and Ankle Orthopedic Fellowship, Department of Orthopedic Surgery, Northwestern Memorial Hospital, Northwestern University, Feinberg School of Medicine, 676 North St. Clair, Suite 1350, Chicago, IL 60611, USA.
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Shen MS, Dodd AC, Lakomkin N, Mousavi I, Bulka C, Jahangir AA, Sethi MK. Open treatment of ankle fracture as inpatient increases risk of complication. J Orthop Traumatol 2017; 18:431-438. [PMID: 29071495 PMCID: PMC5685990 DOI: 10.1007/s10195-017-0472-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 08/23/2017] [Indexed: 11/29/2022] Open
Abstract
Background Ankle fracture is one of the most common injuries treated by orthopaedic surgeons, and its incidence is only expected to rise with an aging population. It is also associated with often costly complications, yet there is little literature on risk factors, especially modifiable ones, driving these complications. The aim of this study is to reveal whether inpatient treatment after ankle fracture is associated with higher incidence of postoperative complications. As the USA moves towards a bundled payment healthcare system, it is imperative that orthopaedists maximize patient outcome and quality of care while also reducing overall costs. Materials and methods We used the American College of Surgeons National Surgical Quality Improvement Program database to compare complication rates between inpatient and outpatient treatment of ankle fracture. We collected patient demographics, comorbidities, and postoperative complications from both groups, then compared treatments using a multinomial logistic regression model. Results We identified 7383 patients, with 2630 (36%) in the outpatient and 2630 (36%) in the inpatient group. Of these, 104 (4.0%) inpatients compared with 52 (2.0%) outpatients developed a complication (p < 0.001). Conclusions Inpatients developed major complications including deep wound infection and pulmonary embolism, as well as minor complications such as pneumonia and urinary tract infection, at significantly greater rates. As reimbursement models begin to incorporate value-based care, orthopaedic surgeons need to be aware of factors associated with increased incidence of postoperative complications. Level of evidence Level III retrospective comparative study.
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Affiliation(s)
- Michelle S Shen
- Vanderbilt Orthopaedic Institute Center for Health Policy, Department of Orthopaedics, Vanderbilt University Medical Center, 1215 21st Avenue South, Suite 4200, Medical Center East, South Tower, Nashville, TN, 37232, USA
| | - Ashley C Dodd
- Vanderbilt Orthopaedic Institute Center for Health Policy, Department of Orthopaedics, Vanderbilt University Medical Center, 1215 21st Avenue South, Suite 4200, Medical Center East, South Tower, Nashville, TN, 37232, USA
| | - Nikita Lakomkin
- Vanderbilt Orthopaedic Institute Center for Health Policy, Department of Orthopaedics, Vanderbilt University Medical Center, 1215 21st Avenue South, Suite 4200, Medical Center East, South Tower, Nashville, TN, 37232, USA
| | - Idine Mousavi
- Vanderbilt Orthopaedic Institute Center for Health Policy, Department of Orthopaedics, Vanderbilt University Medical Center, 1215 21st Avenue South, Suite 4200, Medical Center East, South Tower, Nashville, TN, 37232, USA
| | - Catherine Bulka
- Department of Biostatistics, Vanderbilt University, Nashville, TN, USA
| | - A Alex Jahangir
- Vanderbilt Orthopaedic Institute Center for Health Policy, Department of Orthopaedics, Vanderbilt University Medical Center, 1215 21st Avenue South, Suite 4200, Medical Center East, South Tower, Nashville, TN, 37232, USA
| | - Manish K Sethi
- Vanderbilt Orthopaedic Institute Center for Health Policy, Department of Orthopaedics, Vanderbilt University Medical Center, 1215 21st Avenue South, Suite 4200, Medical Center East, South Tower, Nashville, TN, 37232, USA.
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Abstract
BACKGROUND Ankle fractures are among the most prevalent traumatic orthopaedic injuries. A large proportion of patients sustaining operative ankle fractures are admitted directly from the emergency department prior to operative management. In the authors' experience, however, many closed ankle injuries may be safely and effectively managed on an outpatient basis. The aim of this study was to characterize the economic impact of routine inpatient admission of ankle fractures. METHODS A retrospective review of all outpatient ankle fracture surgery performed by a single foot and ankle fellowship-trained surgeon at a tertiary level academic center in 2012 was conducted to identify any patients requiring postoperative inpatient admission. The National Inpatient Sample was queried for operative management of lateral malleolus, bimalleolar, and trimalleolar ankle fractures in 2012 with regard to national estimates of total volume and length of stay by age. The maximum allowable Medicare inpatient facility reimbursements for diagnosis related group 494 and Medicare outpatient facility reimbursements for Current Procedural Terminology codes 27792, 27814, and 27822 were obtained from the Medicare Acute Inpatient Prospective Pricer and the Medicare Outpatient Pricer Code, respectively. Private facility reimbursement rates were estimated at 139% of inpatient Medicare reimbursement and 280% of outpatient reimbursement, as described in the literature. Surgeon and anesthesiologist fees were considered similar between both inpatient and outpatient groups. A unique stochastic decision-tree model was derived from probabilities and associated costs and evaluated using modified Monte Carlo simulation. RESULTS Of 76 lateral malleolar, bimalleolar, and trimalleolar ankle fracture open reduction internal fixation cases performed in 2012 by the senior author, 9 patients required admission for polytrauma, medical comorbidities, or age. All 67 outpatients were discharged home the day of surgery. In the 2012 national cohort analyzed, 48,044 estimated inpatient admissions occurred postoperatively for closed ankle fractures. The median length of stay was 3 days for each admission and was associated with an estimated facility reimbursement ranging from $12,920 for Medicare reimbursement of lateral malleolus fractures to $18,613 for private reimbursement of trimalleolar fractures. Outpatient facility reimbursements per case were estimated at $4,125 for Medicare patients and $11,459 for private insurance patients. Nationally, annual inpatient admissions accounted for $796,033,050 in reimbursements, while outpatient surgery would have been associated with $419,327,612 for treatment of these same ankle fractures. CONCLUSION In the authors' experience, closed lateral malleolus, bimalleolar, and trimalleolar fractures were safely and effectively treated on an outpatient basis. Routine perioperative admission of patients sustaining ankle fractures likely results in more than $367 million of excess facility reimbursements annually in the United States. Even if a 25% necessary admission rate were assumed, routine inpatient admission of ankle fractures would result in a $282 million excess economic burden annually in the United States. Although in certain cases, inpatient admission may be necessary, with value-based decision making becoming increasingly the responsibility of the orthopaedic surgeon, understanding the implications of inpatient stays for ankle fracture surgery can ultimately result in cost savings to the US health care system and patients individually. LEVEL OF EVIDENCE Level III, comparative series.
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Affiliation(s)
- Justin D Stull
- 1 Rothman Institute Department of Orthopaedics, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Suneel B Bhat
- 1 Rothman Institute Department of Orthopaedics, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Justin M Kane
- 1 Rothman Institute Department of Orthopaedics, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Steven M Raikin
- 1 Rothman Institute Department of Orthopaedics, Thomas Jefferson University Hospital, Philadelphia, PA, USA
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Qin C, Dekker RG, Blough JT, Kadakia AR. Safety and Outcomes of Inpatient Compared with Outpatient Surgical Procedures for Ankle Fractures. J Bone Joint Surg Am 2016; 98:1699-1705. [PMID: 27869620 DOI: 10.2106/jbjs.15.01465] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND As the cost of health-care delivery rises in the era of bundled payments for care, there is an impetus toward minimizing hospitalization. Evidence to support the safety of open reduction and internal fixation (ORIF) of ankle fractures in the outpatient setting is largely anecdotal. METHODS Patients who underwent ORIF from 2005 to 2013 were identified via postoperative diagnoses of ankle fracture and Current Procedural Terminology codes; patients with open fractures and patients who were emergency cases were excluded. Patients undergoing inpatient and outpatient surgical procedures were propensity score-matched to reduce differences in the baseline characteristics. Primary tracked outcomes included medical and surgical complications, readmission, and reoperation within 30 days of the procedure. Binary logistic regression models were created that determined the risk-adjusted relationship between admission status and primary outcomes. RESULTS Outpatient surgical procedures were associated with lower rates of urinary tract infection (0.4% compared with 0.9%; p = 0.041), pneumonia (0.0% compared with 0.5%; p = 0.002), venous thromboembolic events (0.3% compared with 0.8%; p = 0.049), and bleeding requiring transfusion (0.1% compared with 0.6%; p = 0.012). Outpatient status was independently associated with reduced 30-day medical morbidity (odds ratio, 0.344 [95% confidence interval, 0.201 to 0.589]). No significant differences were uncovered with respect to surgical complications (p = 0.076), unplanned reoperations (p = 0.301), and unplanned readmissions (p = 0.358). CONCLUSIONS In patients with closed fractures and minimal comorbidities, outpatient ORIF was associated with reduced risk of select 30-day medical morbidity and no difference in surgical morbidity, reoperations, and readmissions relative to inpatient. Factors unaccounted for when creating matched cohorts may impact our results. Our findings lend reassurance to surgeons who defer admission for low-risk patients. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Charles Qin
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Robert G Dekker
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jordan T Blough
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Anish R Kadakia
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Sughrue ME, Bonney PA, Choi L, Teo C. Early Discharge After Surgery for Intra-Axial Brain Tumors. World Neurosurg 2015; 84:505-10. [DOI: 10.1016/j.wneu.2015.04.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 04/08/2015] [Accepted: 04/10/2015] [Indexed: 11/28/2022]
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Friedman J, Ly A, Mauffrey C, Stahel PF. Temporary transarticular K-wire fixation of critical ankle injuries at risk: a neglected "damage control" strategy? Orthopedics 2015; 38:122-7. [PMID: 25665111 DOI: 10.3928/01477447-20150204-05] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
High-energy ankle fracture-dislocations are at significant risk for postoperative complications. Closed reduction and temporary percutaneous transarticular K-wire fixation was first described more than 50 years ago. This simple and effective "damage control" strategy is widely practiced in Europe, yet appears largely forgotten and abandoned in the United States. Anecdotal opposing arguments include the notion that drilling K-wires through articular cartilage may damage the joint and contribute to postinjury arthritis. This article describes the experience in a US academic level I trauma center with transarticular pinning of selected critical ankle fracture-dislocations followed by delayed definitive fracture fixation once the soft tissues are healed. Median patient follow-up of 2 years showed that the transarticular pinning technique was performed safely, not associated with increased postoperative complication rates, and characterized by good subjective outcomes using the American Academy of Orthopaedic Surgeons Foot and Ankle Outcome Score questionnaire.
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Kadous A, Abdelgawad AA, Kanlic E. Deep venous thrombosis and pulmonary embolism after surgical treatment of ankle fractures: a case report and review of literature. J Foot Ankle Surg 2012; 51:457-63. [PMID: 22632837 DOI: 10.1053/j.jfas.2012.04.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Indexed: 02/03/2023]
Abstract
Deep vein thrombosis and pulmonary embolism are major complications that can occur after ankle injuries. We present the case of a patient with an ankle fracture who developed deep vein thrombosis and massive pulmonary embolism after surgical treatment of the ankle fracture. A review of the published data on this topic is presented. The treating physician should assess patients with ankle fracture for their risk of developing a venous thromboembolic event on an individual basis and provide thromboprophylaxis for those with an increased risk of developing such complications.
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Affiliation(s)
- Adel Kadous
- Department of Orthopedic Surgery, Paul L. Foster School of Medicine, Texas Tech University Health Science Center at El Paso, El Paso, TX 79912, USA
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