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Tian J, Miao J, Jiang Z, Li Z. Comparison of operatively and nonoperatively treated isolated Weber B ankle fractures: a systematic review and meta-analysis. J Orthop Surg Res 2024; 19:346. [PMID: 38858737 PMCID: PMC11163742 DOI: 10.1186/s13018-024-04835-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Accepted: 06/04/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND Despite fractures of Isolated Weber B being prevalent, there is a lack of clarity regarding the relative effectiveness of surgical versus conservative treatment. This systematic review and meta-analysis aimed to investigate the clinical effects and complications of surgical versus conservative treatment of the Isolated Weber B ankle fractures. METHODS This study involved thorough searches across multiple electronic databases, including PubMed, Cochrane, Embase, and Web of Science, to identify all relevant publications on Isolated Weber B ankle fractures repaired through surgical versus conservative treatment. Through a comprehensive meta-analysis, several outcomes were evaluated, including post-operative function, complications and reoperation rate. RESULT Six articles involving 818 patients who met the inclusion criteria. Among these participants, 350 were male and 636 were female. 651 patients received conservative treatment, while 396 underwent surgical intervention. The findings indicate no significant differences in OMAS, FAOQ, PCS, MCS scores, and return to work between surgical and non-surgical treatments for isolated Weber B ankle fractures. However, compared with surgical treatment, non-surgical treatment has a higher AOFAS score(MD = -5.31, 95% CI = [-9.06, -1.55], P = 0.20, I2 = 39%), lower VAS score(MD = 0.72, 95% CI = [0.33, 1.10], P = 0.69, I2 = 0%), lower complication rate (RR = 3.06, 95% CI = [1.58, 6.01], P = 0.05, I2 = 54%), and lower reoperation rate(RR = 8.40, 95% CI = [1.57, 45.06], P = 0.05, I2 = 67%). CONCLUSION
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Affiliation(s)
- Jinhui Tian
- Department of Orthopedic Surgery, Handan Central Hospital, 15 South Zhonghua Street, Handan, Hebei, 056008, China
| | - Jie Miao
- Department of Orthopedic Surgery, Handan Central Hospital, 15 South Zhonghua Street, Handan, Hebei, 056008, China
| | - Zhongchao Jiang
- Department of Orthopedic Surgery, Handan Central Hospital, 15 South Zhonghua Street, Handan, Hebei, 056008, China
| | - Zhiyuan Li
- Department of Orthopedic Surgery, Handan Central Hospital, 15 South Zhonghua Street, Handan, Hebei, 056008, China.
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Nian P, Elali F, Voyvodic LC, Rodriguez AN, Ng MK, Abdelgawad AA, Razi AE. Comparison of Patient Demographics and Risk of Surgical Site Infections Following Open Reduction and Internal Fixation of Trimalleolar Ankle Fractures: A Nationwide Analysis of a Private Payor. J Foot Ankle Surg 2024:S1067-2516(24)00071-1. [PMID: 38679410 DOI: 10.1053/j.jfas.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 03/05/2024] [Accepted: 04/06/2024] [Indexed: 05/01/2024]
Abstract
Surgical site infections (SSIs) are a notable complication following open reduction and internal fixation (ORIF) for ankle fractures. The purpose of this study was to (1) compare baseline demographics of patients who did and did not develop SSIs within 90 days following ORIF for trimalleolar ankle fractures and (2) identify risk factors associated with SSIs in this setting. A retrospective analysis from 2010 to 2020 was completed using a national administrative database. The study group consisted of patients who underwent ORIF for trimalleolar ankle fractures and developed SSIs within 90 days postoperatively. Patients without SSIs served as the comparison cohort. Baseline demographics of the two cohorts were compared utilizing Pearson's Chi-Square Analyses. A multivariate binomial logistic regression model determined the association of various comorbidities on developing SSIs in this setting. Out of a total sample of 22,118 patients, 1000 individuals (4.52%) developed SSIs. The study revealed that the SSI cohort exhibited a greater burden of comorbidities, as evidenced by significant differences in various individual comorbidities and average Elixhauser-Comorbidity Indices scores. The most strongly associated risk factors for the development of SSIs following ORIF for trimalleolar ankle fractures were peripheral vascular disease (OR: 1.53, p < .0001), diabetes mellitus (OR: 1.26, p = .0010), iron deficiency anemia (OR: 1.24, p = .0010), male sex (OR: 1.22, p = .0010), and tobacco use (OR: 1.15, p = .0010). This study identified several patient risk factors that were associated with developing SSIs after ORIF for trimalleolar ankle fractures, recognizing potential patient-directed interventions that may reduce the rate of SSIs in this setting.
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Affiliation(s)
- Patrick Nian
- Maimonides Medical Center, Department of Orthopaedic Surgery, Brooklyn, New York, NY; State University of New York (SUNY) Downstate, School of Medicine, Brooklyn, New York, NY
| | - Faisal Elali
- Maimonides Medical Center, Department of Orthopaedic Surgery, Brooklyn, New York, NY; State University of New York (SUNY) Downstate, School of Medicine, Brooklyn, New York, NY
| | - Lucas C Voyvodic
- Maimonides Medical Center, Department of Orthopaedic Surgery, Brooklyn, New York, NY; State University of New York (SUNY) Downstate, School of Medicine, Brooklyn, New York, NY
| | - Ariel N Rodriguez
- Maimonides Medical Center, Department of Orthopaedic Surgery, Brooklyn, New York, NY.
| | - Mitchell K Ng
- Maimonides Medical Center, Department of Orthopaedic Surgery, Brooklyn, New York, NY
| | - Amr A Abdelgawad
- Maimonides Medical Center, Department of Orthopaedic Surgery, Brooklyn, New York, NY
| | - Afshin E Razi
- Maimonides Medical Center, Department of Orthopaedic Surgery, Brooklyn, New York, NY
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Zaboli Mahdiabadi M, Farhadi B, Shahroudi P, Mohammadi M, Omrani A, Mohammadi M, Hekmati Pour N, Hojjati H, Najafi M, Majd Teimoori Z, Farzan R, Salehi R. Prevalence of surgical site infection and risk factors in patients after knee surgery: A systematic review and meta-analysis. Int Wound J 2024; 21:e14765. [PMID: 38351472 PMCID: PMC10864688 DOI: 10.1111/iwj.14765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 01/25/2024] [Accepted: 01/28/2024] [Indexed: 02/16/2024] Open
Abstract
The present systematic review and meta-analysis aimed to determine the prevalence of surgical site infection (SSI) and risk factors in patients after knee surgery. A comprehensive and systematic search was carried out across various international electronic databases, including Scopus, PubMed and Web of Science, as well as Persian electronic databases like Iranmedex and the Scientific Information Database (SID). This search involved the utilization of keywords derived from Medical Subject Headings, such as 'Prevalence', 'Surgical wound infection', 'Surgical site infection' and 'Orthopaedics', spanning from the earliest records up to 1 October 2023. To assess the quality of the included studies, the Appraisal tool for Cross-Sectional Studies (AXIS tool) was utilized. The study encompassed a combined participant pool of 11 028 individuals who underwent knee surgery across seven selected studies. The collective prevalence of SSI in patients who underwent knee surgery, as reported in the seven included studies, was determined to be 3.0% (95% CI: 1.2% to 7.5%; I2 = 96.612%; p < 0.001). The combined prevalence of SSI in patients with DM, as reported in six studies, was 5.1% (95% CI: 1.7% to 14.5%; I2 = 79.054%; p < 0.001). Similarly, the pooled prevalence of SSI in patients with HTN, drawn from four studies, was 1.8% (95% CI: 0.7% to 4.5%; I2 = 63.996%; p = 0.040). Additionally, the collective prevalence of SSI in patients with a history of tobacco use, based on findings from six studies, was 4.8% (95% CI: 1.4% to 15.2%; I2 = 93.358%; p < 0.001). Subgroup analysis was conducted within six studies, categorizing them by two countries, namely China and the USA. These analyses revealed that the prevalence of SSI following knee surgery was 3.0% in China and 2.0% in the USA. It is noteworthy that variations in SSI prevalence across different studies may be attributed to a multitude of factors, particularly varying risk factors among patient populations. To address this issue and mitigate the impact of SSI on knee surgery patients, it is advisable to develop tailored interventions.
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Affiliation(s)
| | - Bahar Farhadi
- School of MedicineIslamic Azad University, Mashhad BranchMashhadIran
| | - Parinaz Shahroudi
- Department of Surgical TechnologyGuilan University of Medical SciencesRashtIran
| | - Mohsen Mohammadi
- Department of Medical Surgical NursingGuilan University of Medical SciencesRashtIran
| | - Amin Omrani
- Department of Physical Therapy, School of MedicineTehran University of Medical SciencesTehranIran
| | - Maryam Mohammadi
- Department of Physical Therapy, School of MedicineUniversity of Social Welfare and Rehabilitation SciencesTehranIran
| | - Nafiseh Hekmati Pour
- Department of NursingAliabad Katoul Branch, Islamic Azad UniversityAliabad KatoulIran
| | - Hamid Hojjati
- Nursing Research Center, Golestan University of Medical SciencesGorganIran
| | - Masoomeh Najafi
- Student Research Committee, School of Nursing and MidwiferyShahid Beheshti University of Medical SciencesTehranIran
| | - Zahra Majd Teimoori
- Shahid Beheshti School of Nursing and MidwiferyGuilan University of Medical SciencesRashtIran
| | - Ramyar Farzan
- Department of Plastic & Reconstructive Surgery, School of MedicineGuilan University of Medical SciencesRashtIran
| | - Reza Salehi
- Department of Anesthesiology, School of MedicineIran University of Medical SciencesTehranIran
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Cheng J, Zhang L, Zhang J, Asadi K, Farzan R. Prevalence of surgical site infection and risk factors in patients after foot and ankle surgery: A systematic review and meta-analysis. Int Wound J 2024; 21:e14350. [PMID: 37606302 PMCID: PMC10781588 DOI: 10.1111/iwj.14350] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 07/30/2023] [Accepted: 08/01/2023] [Indexed: 08/23/2023] Open
Abstract
The present systematic review and meta-analysis aimed to determine the prevalence of surgical site infection (SSI) and related factors in patients after foot and ankle surgery. A comprehensive, systematic search was conducted in different international electronic databases, such as Scopus, PubMed, Web of Science and Persian electronic databases such as Iranmedex and Scientific Information Database (SID) using keywords extracted from Medical Subject Headings such as 'Prevalence', 'Surgical wound infection', 'Surgical site infection' and 'Orthopaedics' from the earliest to 1 June 2023. The appraisal tool for cross-sectional studies (AXIS tool) evaluates the quality of the included studies. A total of 10 447 patients undergoing foot and ankle surgery participated in nine studies. The pooled prevalence of SSI in patients who underwent foot and ankle surgery was reported in nine studies was 4.2% (95% CI: 2.4%-7.2%; I2 = 96.793%; p < 0.001). The odds ratio of SSI prevalence in men was higher than that of women and was significant (OR: 1.335; 95% CI: 1.106-1.612; Z = 3.009; p = 0.003). The pooled prevalence of SSI in patients with hindfoot fracture sites reported in five studies was 4.9% (95% CI: 2.6%-8.9%; I2 = 90.768%; p < 0.001). The pooled prevalence of SSI in patients with diabetes mellitus (DM) reported in six studies was 9.1% (95% CI: 5.6%-14.6%; I2 = 73.957%; p = 0.002). The pooled prevalence of SSI in patients with hypertension (HTN) reported in five studies was 5.5% (95% CI: 2.5%-11.6%; I2 = 91.346%; p < 0.001). The pooled prevalence of SSI in patients with tobacco use reported in eight studies was 6.6% (95% CI: 4.1%-10.4%; I2 = 85.379%; p < 0.001). In general, the existing differences in the prevalence of SSI after foot and ankle surgery in different studies can be based on different risk factors such as comorbidities and gender. Therefore, it is suggested to design appropriate interventions to reduce SSI in these patients.
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Affiliation(s)
- Jiaguo Cheng
- Department of Hospital Infection ManagementAffiliated Hospital of Panzhihua UniversityPanzhihuaChina
| | - Luping Zhang
- Department of Blood TransfusionAffiliated Hospital of Panzhihua UniversityPanzhihuaChina
| | - Jing Zhang
- Department of Administrative OfficeAffiliated Hospital of Panzhihua UniversityPanzhihuaChina
| | - Kamran Asadi
- Department of Orthopedics, Orthopedic Research Center, Poorsina Hospital, Faculty of MedicineGuilan University of Medical SciencesRashtIran
| | - Ramyar Farzan
- Department of Plastic & Reconstructive Surgery, School of MedicineGuilan University of Medical SciencesRashtIran
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Bergström J, Möller Rydberg E, Wennergren D, Svensson Malchau K. Incidence and Risk Factors for Surgical Site Infection in Ankle Fractures: An Observational Study of 480 Patients in Sweden. J Clin Med 2023; 12:6464. [PMID: 37892601 PMCID: PMC10607575 DOI: 10.3390/jcm12206464] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/07/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
INTRODUCTION Surgical site infection (SSI) is a frequently reported complication after ankle fracture surgery. To our knowledge, no study has been conducted on its incidence in Sweden. The present study aimed to determine the incidence of, risk factors for, and most common causative pathogen of SSI. METHODS Patients who underwent primary surgery for an ankle fracture between 1 September 2017 and 31 August 2019 at the Sahlgrenska University Hospital were identified. Data on potential SSI risk factors and clinical outcome (infected/non-infected) were retrieved from medical records. Cox regression analysis and descriptive statistics were used. RESULTS Of the 480 reviewed patients, 49 developed SSI (10.2%), of which 35 (7.3%) were superficial and 14 (2.9%) were deep. Open fractures (p < 0.001) and age (p = 0.016) were statistically significant risk factors for SSI in the univariate analysis. In the multivariable analysis, only open fracture was statistically significant (HR = 3.0; 95% C.I. = 1.3-6.9, p = 0.013). Cases of Staphylococcus aureus (S. aureus) were most common (n = 12, 24.5%). Methicillin resistance was uncommon (n = 2, 4.1%). CONCLUSIONS An incidence of 10.2% was established, which is comparable to international findings. Infection monitoring is an important part of tackling the global challenge of antibiotic resistance. Future prospective studies to further establish risk factors are warranted to decrease the incidence of SSI.
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Affiliation(s)
- Johanna Bergström
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden; (E.M.R.); (D.W.); (K.S.M.)
| | - Emilia Möller Rydberg
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden; (E.M.R.); (D.W.); (K.S.M.)
- Department of Orthopaedics, Sahlgrenska University Hospital, 413 80 Gothenburg, Sweden
| | - David Wennergren
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden; (E.M.R.); (D.W.); (K.S.M.)
- Department of Orthopaedics, Sahlgrenska University Hospital, 413 80 Gothenburg, Sweden
| | - Karin Svensson Malchau
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden; (E.M.R.); (D.W.); (K.S.M.)
- Department of Orthopaedics, Sahlgrenska University Hospital, 413 80 Gothenburg, Sweden
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Pilskog K, Høvding P, Fenstad AM, Inderhaug E, Fevang JM, Dale H. Risk factors for fracture-related infection after ankle fracture surgery. Injury 2023; 54:111011. [PMID: 37688812 DOI: 10.1016/j.injury.2023.111011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/21/2023] [Accepted: 08/30/2023] [Indexed: 09/11/2023]
Abstract
INTRODUCTION Ankle fracture surgery comes with a risk of fracture-related infection (FRI). Identifying risk factors are important in preoperative planning, in management of patients, and for information to the individual patient about their risk of complications. In addition, modifiable factors can be addressed prior to surgery. The aim of the current paper was to identify risk factors for FRI in patients operated for ankle fractures. METHODS A cohort of 1004 patients surgically treated for ankle fractures at Haukeland University Hospital in the period of 2015-2019 was studied retrospectively. Patient charts and radiographs were assessed for the diagnosis of FRI. Binary logistic regression was used in analyses of risk factors. Regression coefficients were used to calculate the probability for FRI based on the patients' age and presence of one or more risk factors. RESULTS FRI was confirmed in 87 (9%) of 1004 patients. Higher age at operation (p < .001), congestive heart failure (CHF), p = 0.006), peripheral artery disease (PAD, p = 0.001), and current smoking (p = .006) were identified as risk factors for FRI. PAD and CHF were the risk factors displaying the strongest association with FRI with an adjusted odds ratio of 4.2 (95% CI 1.8-10.1) and 4.7 (95% CI 1.6-14.1) respectively. CONCLUSION The prevalence of FRI was 9% after surgical treatment of ankle fractures. The combination of risk factors found in this study demonstrate the need for a thorough, multidisciplinary, and careful approach when faced with an elderly or frail patient with an ankle fracture. The results of this study help the treating surgeons to inform their patients of the risk of FRI prior to ankle fracture surgery. LEVEL OF EVIDENCE Level III retrospective case-control study.
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Affiliation(s)
- Kristian Pilskog
- Department of Orthopaedic Surgery, Haukeland University Hospital, Pb 1400, Bergen 5021, Norway; Department of Clinical Medicine (K1), University of Bergen, Norway Pb 7804, Bergen 5020, Norway.
| | - Pål Høvding
- Department of Orthopaedic Surgery, Haukeland University Hospital, Pb 1400, Bergen 5021, Norway
| | - Anne Marie Fenstad
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Eivind Inderhaug
- Department of Orthopaedic Surgery, Haukeland University Hospital, Pb 1400, Bergen 5021, Norway; Department of Clinical Medicine (K1), University of Bergen, Norway Pb 7804, Bergen 5020, Norway
| | - Jonas Meling Fevang
- Department of Orthopaedic Surgery, Haukeland University Hospital, Pb 1400, Bergen 5021, Norway; Department of Clinical Medicine (K1), University of Bergen, Norway Pb 7804, Bergen 5020, Norway
| | - Håvard Dale
- Department of Orthopaedic Surgery, Haukeland University Hospital, Pb 1400, Bergen 5021, Norway; Department of Clinical Medicine (K1), University of Bergen, Norway Pb 7804, Bergen 5020, Norway
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Kang HJ, Kwon YM, Byeon SJ, Kim HN, Sung IH, Subramanian SA, Kim SJ. Trends and Risk Factors for Surgical Site Infection after Treatment of the Ankle Fracture: National Cohort Study. J Clin Med 2023; 12:4215. [PMID: 37445250 DOI: 10.3390/jcm12134215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/13/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
Surgical site infection (SSI) is a major complication after the surgical treatment of ankle fractures that can result in catastrophic consequences. This study aimed to determine the incidence of SSI in several cohorts from national insurance databases over the past 12 years and identify its predictors. The claimed data for patients (n = 1,449,692) with ankle fractures between 2007 and 2019 were investigated, and a total of 41,071 patients were included in the final analysis. The covariates included were age, sex, season, fracture type (closed vs. open), type of surgical fixation procedure, and comorbidities of each patient. All subjects were divided into two groups according to the SSI after the surgical fixation of the ankle fracture (no infection group vs. infection group). The number of SSIs after the surgical treatment of ankle fractures was 874 (2.13%). Open fractures [odds ratio, (OR) = 4.220] showed the highest risk for SSI, followed by the male sex (OR = 1.841), an increasing number of comorbidities (3-5, OR = 1.484; ≥6, OR = 1.730), a history of dementia (OR = 1.720) or of myocardial infarction (OR = 1.628), and increasing age (OR = 1.010). The summer season (OR = 1.349) showed the highest risk among the four seasons for SSI after ankle fracture surgery.
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Affiliation(s)
- Hwa-Jun Kang
- Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong 18450, Republic of Korea
| | - Young-Min Kwon
- Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong 18450, Republic of Korea
| | - Sun-Ju Byeon
- Department of Pathology, Yuseong Sun Hospital, Daejeon 34084, Republic of Korea
| | - Hyong Nyun Kim
- Department of Orthopedic Surgery, Hallym University Kangnam Sacred Heart Hospital, Seoul 07441, Republic of Korea
| | - Il-Hoon Sung
- Department of Orthopedic Surgery, Hanyang University Hospital, Seoul 04763, Republic of Korea
| | - Sivakumar Allur Subramanian
- Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong 18450, Republic of Korea
| | - Sung Jae Kim
- Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong 18450, Republic of Korea
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Ubillus HA, Samsonov AP, Azam MT, Forney MP, Jimenez Mosquea TR, Walls RJ. Implications of obesity in patients with foot and ankle pathology. World J Orthop 2023; 14:294-301. [PMID: 37304200 PMCID: PMC10251267 DOI: 10.5312/wjo.v14.i5.294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/05/2023] [Accepted: 03/20/2023] [Indexed: 05/18/2023] Open
Abstract
Obesity is a growing problem defined as a body mass index of greater than 30 kg/m2. It is predicted that by 2030, 48.9% of adults will be classified as obese which expands surgical risk factors to a broad population while increasing healthcare costs at the same time in different socioeconomic groups. This specific population has been widely studied in multiple surgical fields and published studies have shown the implications in each of these fields. The impact of obesity on orthopedic surgical outcomes has been previously reported in several total hip and knee arthroscopy studies, with evidence indicating that obesity is strongly associated with an increased risk of post operative complications together with higher revision rates. In line with increasing interest on the impact of obesity in orthopedics, there has been a similar output of publications in the foot and ankle literature. This review article evaluates several foot and ankle pathologies, their risk factors associated with obesity and subsequent management. It provides an updated, comprehensive analysis of the effects of obesity on foot and ankle surgical outcomes, with the ultimate aim of educating both surgeons and allied health professionals about the risks, benefits, and modifiable factors of operating on obese patients.
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Affiliation(s)
- Hugo A Ubillus
- Department of Orthopedic Surgery, NYU Langone Health, New York City, NY 10002, United States
| | - Alan P Samsonov
- Department of Orthopedic Surgery, NYU Langone Health, New York City, NY 10002, United States
| | - Mohammad T Azam
- Department of Orthopedic Surgery, NYU Langone Health, New York City, NY 10002, United States
| | - Megan P Forney
- Department of Surgery, University of Cincinnati, Cincinnati, OH 45267, United States
| | | | - Raymond J Walls
- Department of Orthopedic Surgery, NYU Langone Health, New York City, NY 10002, United States
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Surgical treatment of displaced isolated lateral malleolar fractures: incidence of adverse events requiring revision: a retrospective cohort study. J Orthop Surg Res 2022; 17:252. [PMID: 35505429 PMCID: PMC9066775 DOI: 10.1186/s13018-022-03135-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 04/19/2022] [Indexed: 11/12/2022] Open
Abstract
Background Recent systematic reviews support that non-operative management should be the standard treatment for all stable isolated lateral malleolar fractures (ILMFs), regardless of fibular fracture displacement. Surgical fixation of ILMFs carries a risk of adverse events (AEs), and many patients will later require implant removal. We wanted to estimate the incidence of AEs requiring revision after surgical fixation of “potentially stable” displaced ILMFs before non-operative treatment became standard care in our department. Materials and methods To identify patients with “potentially stable” ILMFs who had been treated surgically in a historical cohort, we retrospectively applied the stability-based classification system, introduced by Michelson et al., to a cohort of 1006 patients with ankle fractures treated surgically from 2011 to 2016. The primary outcome of this retrospective cohort study was the incidence of AEs that had functionally significant adverse effects on outcome and required revision in the first 12 months after surgery. AEs were graded and categorized using the Orthopedic Surgical Adverse Events Severity (OrthoSAVES) System. Results The study population comprised 108 patients with “potentially stable” displaced ILMFs; 4 patients (3.7% [95% CI (0.1–7.3%]) experienced AEs requiring revision in the first twelve months after surgery. There were 5 additional patients (4.6%) with functionally significant AEs where revision surgery was not indicated within the first twelve months after surgical fixation. A further 5 patients (4.6%) had AEs managed in the outpatient clinic (grade II); 36 patients (33.3%) required secondary implant removal due to implant-related discomfort. Conclusions Surgical fixation of ILMFs carries a risk of severe AEs, and many patients will subsequently need implant-removal procedures. Further prospective studies are required to ascertain whether non-operative treatment can lower the risk of AEs and the need for additional surgical procedures. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-022-03135-z.
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