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Stigevall C, Möller M, Wennergren D, Wolf O, Ekelund J, Bergdahl C. Patients with more complex ankle fractures are associated with poorer patient-reported outcome: an observational study of 11,733 patients from the Swedish Fracture Register. Acta Orthop 2024; 95:212-218. [PMID: 38712854 PMCID: PMC11075523 DOI: 10.2340/17453674.2024.40607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 03/28/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND AND PURPOSE Patient-reported outcome measures (PROMs) following ankle fractures, including all fracture types, have not been reported. It is therefore unclear whether fracture morphology correlates with outcome. We aimed to analyze PROMs in patients with an ankle fracture in relation to the Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) fracture classification using population-based register data from the Swedish Fracture Register (SFR). METHODS All patients aged ≥ 18 years with an ankle fracture (AO/OTA 44A1-C3) registered in the SFR between 2012 and 2019 were retrieved from the register. Patients with completed PROM questionnaires (Short Musculoskeletal Function Assessment and EuroQol-Visual Analogue Scale) on both day 0 (pre-trauma) and 1-year post-trauma were included. The difference in PROMs between day 0 and 1 year was calculated for each patient (delta value) and mean delta values were calculated at group level, based on the AO/OTA fracture classification. RESULTS 11,733 patients with 11,751 fractures with complete PROMs were included. According to the AO/OTA classification, 21% were A fractures, 67% were B fractures and 12% were C fractures. All groups of patients, regardless of fracture class (A1-C3), displayed an impairment in PROMs after 1 year compared with day 0. Type C fractures displayed a larger impairment in PROMs at group level than type B, which in turn had a greater impairment than type A. The same pattern was seen in groups 3, 2, and 1 for A and B fractures. CONCLUSION We found that the AO/OTA classification is prognostic, where more complex fractures were associated with poorer PROMs.
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Affiliation(s)
- Caroline Stigevall
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg; Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg/Mölndal.
| | - Michael Möller
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg; Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg/Mölndal
| | - David Wennergren
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg; Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg/Mölndal
| | - Olof Wolf
- Department of Surgical Sciences, Orthopedics, Uppsala University, Uppsala
| | - Jan Ekelund
- Center of Registers Västra Götaland, Gothenburg, Sweden
| | - Carl Bergdahl
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg; Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg/Mölndal
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Sankey T, Sanchez T, McGee AS, Scheinberg M, Underwood M, Young M, Shah A. Factors Influencing PROMIS Scores and Patient Reported Outcomes Following Surgical Intervention of Isolated Lisfranc Injury: Minimum 2 Year Follow-up. J Foot Ankle Surg 2024; 63:359-365. [PMID: 38246337 DOI: 10.1053/j.jfas.2024.01.005] [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: 06/08/2023] [Revised: 12/22/2023] [Accepted: 01/03/2024] [Indexed: 01/23/2024]
Abstract
Lisfranc injuries are rare but significant foot injuries, as they often result from polytrauma patients, and are often misdiagnosed, which further complicate their evaluation and contribute to their propensity towards disability. It is recommended that, on diagnosis, Lisfranc injuries be treated as soon as possible to decrease the risk of future chronic pain, disability, or osteoarthritis. Our study evaluated patients who completed the patient reported outcome measurement information systems (PROMIS) along with the foot function index (FFI) following operative fixation for Lisfranc injury. Fifty-one patients between 2010 and 2020 met inclusion criteria and were selected for this study, with completion. Utilizing the electronic medical record (EMR), patient charts were reviewed to obtain basic patient demographic information and comorbidities. Operative reports were reviewed to determine which procedure was performed for definitive fixation. Primary arthrodesis was associated with a significant decrease in complication rates (p = .025) when compared to ORIF. Females, arthrodesis, and procedures using a home run (HR) screw were independent risk factors for significantly higher reports of PROMIS pain interference. Arthrodesis also was associated with lower PROMIS pain interference scores. Arthrodesis and males exhibited higher scores in all FFI categories. Our results provide evidence that patient reported outcomes following Lisfranc surgery reported via PROMIS, FFI and VAS scores are independently influenced by patient demographics, comorbidities, and surgical variables. Analysis of potential associations between these patient characteristics and PROMIS and FFI scores provides evidence for physicians to manage patient expectations prior to operative treatment of a nonpolytraumatic Lisfranc injury.
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Affiliation(s)
- Turner Sankey
- Department of Orthopaedic Surgery, University of Alabama, Birmingham, AL
| | - Thomas Sanchez
- Department of Orthopaedic Surgery, University of Alabama, Birmingham, AL
| | - Andrew S McGee
- Department of Orthopaedic Surgery, University of Alabama, Birmingham, AL
| | - Mila Scheinberg
- Department of Orthopaedic Surgery, University of Alabama, Birmingham, AL
| | - Meghan Underwood
- Department of Orthopaedic Surgery, University of Alabama, Birmingham, AL
| | - Matt Young
- Department of Orthopaedic Surgery, University of Alabama, Birmingham, AL
| | - Ashish Shah
- Department of Orthopaedic Surgery, University of Alabama, Birmingham, AL.
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Lorente A, Pelaz L, Palacios P, Benlloch M, de la Rubia Ortí JE, Barrios C, Mariscal G, Lorente R. Predictive Factors of Functional Outcomes and Quality of Life in Patients with Ankle Fractures: A Systematic Review. J Clin Med 2024; 13:1188. [PMID: 38592026 PMCID: PMC10932135 DOI: 10.3390/jcm13051188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/17/2024] [Accepted: 02/10/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Evaluating the predictors of unfavorable outcomes in patients with ankle fractures is crucial for identifying high-risk patients and implementing personalized treatment strategies. This study aimed to analyze factors that influence quality of life in patients with ankle fractures. Methods: Four databases were consulted. The main outcomes were functionality and quality of life scales combined using the standard mean difference (SMD) (Review Manager 5.4). Results: Eight studies with 2486 patients were included. A significant correlation was found between female sex and worse functionality scores (beta 4.15, 95% CI 1.84-6.46). Additionally, older age was correlated with worse functionality scores (beta -0.24, 95% CI -0.29 to -0.19). Patients with diabetes or metabolic syndrome also had worse outcomes (SMD 0.27, 95% CI 0.18-0.36). High BMI and obesity were also associated with worse quality of life scores (beta 2.62, 95% CI 0.77-4.48). Smokers had greater disability in the analyzed scales (SMD 0.22, 95% CI 0.05-0.39). No significant differences were observed with respect to syndesmotic involvement. Conclusions: Age, sex, diabetes, high BMI, and smoking negatively impact functional outcomes and quality of life in patients with ankle fractures.
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Affiliation(s)
- Alejandro Lorente
- Ankle and Foot Surgery Unit, Department of Traumatology and Orthopaedic Surgery, University Hospital Ramón y Cajal, 28034 Madrid, Spain; (A.L.); (L.P.)
| | - Leire Pelaz
- Ankle and Foot Surgery Unit, Department of Traumatology and Orthopaedic Surgery, University Hospital Ramón y Cajal, 28034 Madrid, Spain; (A.L.); (L.P.)
| | - Pablo Palacios
- Department of Traumatology and Orthopaedic Surgery, Sanchinarro University Hospital, 28050 Madrid, Spain;
| | - María Benlloch
- Department of Basic Medical Sciences, Catholic University of Valencia, 46001 Valencia, Spain; (M.B.); (J.E.d.l.R.O.)
| | - José Enrique de la Rubia Ortí
- Department of Basic Medical Sciences, Catholic University of Valencia, 46001 Valencia, Spain; (M.B.); (J.E.d.l.R.O.)
| | - Carlos Barrios
- Institute for Research on Musculoskeletal Disorders, School of Medicine, Valencia Catholic University, 46001 Valencia, Spain;
| | - Gonzalo Mariscal
- Institute for Research on Musculoskeletal Disorders, School of Medicine, Valencia Catholic University, 46001 Valencia, Spain;
| | - Rafael Lorente
- Department of Orthopedic Surgery and Traumatology, University Hospital of Badajoz, 06006 Badajoz, Spain;
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Reyes-Valdés A, Martínez-Ledezma M, Fernández-Quezada D, Guzmán-Esquivel J, Cárdenas-Rojas MI. Prevalence and Characteristics of Patients Requiring Surgical Reinterventions for Ankle Fractures. J Clin Med 2023; 12:5843. [PMID: 37762784 PMCID: PMC10532131 DOI: 10.3390/jcm12185843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/11/2023] [Accepted: 08/16/2023] [Indexed: 09/29/2023] Open
Abstract
(1) Background: Ankle fractures are common injuries that typically require surgical treatment. Complications may arise, leading to reinterventions with poor recovery and reduced quality of life for patients. The aim of this study was to determine the number of patients who underwent surgical reintervention for ankle fractures, characteristics, and associated factors. (2) Methods: A cross-sectional study was conducted to analyze the number of patients requiring surgical intervention for ankle fractures at General Hospital Zone No1 IMSS in Colima over a period of two years. The age, gender, comorbidities, laterality, cause of surgical reintervention, Weber classification, and elapsed time to reintervention were analyzed. (3) Results: A total of 33 patients were included in this study, of whom 63.3% were male, ranging in age from 18 to 51 years old. The predominant Danis-Weber classification for both sexes was suprasyndesmotic fracture (Type C). No established relationship was found between comorbidities and surgical reintervention; however, a significant relationship was observed between home accidents and the need for reintervention. (4) Conclusions: Reintervention in patients previously operated on for ankle fractures is more frequent in male patients and those who sustained the injury at home.
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Affiliation(s)
- Abraham Reyes-Valdés
- Hospital General de Zona No. 1, Instituto Mexicano del Seguro Social, Av. Lapislázuli No. 250 Colonia La Haya, Villa de Álvarez, Colima 28984, Mexico; (A.R.-V.); (M.M.-L.)
| | - Mirna Martínez-Ledezma
- Hospital General de Zona No. 1, Instituto Mexicano del Seguro Social, Av. Lapislázuli No. 250 Colonia La Haya, Villa de Álvarez, Colima 28984, Mexico; (A.R.-V.); (M.M.-L.)
| | - David Fernández-Quezada
- Centro Universitario de Ciencias de la Salud (CUCS), Laboratorio de Microscopía de Alta Resolución, Departamento de Neurociencias, Universidad de Guadalajara, Guadalajara 44340, Mexico;
| | - José Guzmán-Esquivel
- Unidad de Investigación en Epidemiología Clínica, Instituto Mexicano del Seguro Social, Av. Lapislázuli No. 250 Colonia La Haya, Villa de Álvarez, Colima 28984, Mexico;
| | - Martha Irazema Cárdenas-Rojas
- Unidad de Investigación en Epidemiología Clínica, Instituto Mexicano del Seguro Social, Av. Lapislázuli No. 250 Colonia La Haya, Villa de Álvarez, Colima 28984, Mexico;
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Karaismailoglu B, Yıldırım O, Aslan L, Yontar NS, Guven MF, Kaynak G, Ogut T. Middle-sized posterior malleolus fractures: Fixed versus non-fixed - A prospective randomized study. Foot Ankle Surg 2023; 29:329-333. [PMID: 37062618 DOI: 10.1016/j.fas.2023.04.005] [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: 11/18/2022] [Revised: 04/04/2023] [Accepted: 04/08/2023] [Indexed: 04/18/2023]
Abstract
PURPOSE This study aimed to assess the impact of fixation on functional and radiological outcomes of ankle fractures involving the posterior malleolus. We hypothesized that fixation of the posterior malleolus would be associated with improved radiological and functional outcome. METHODS A prospective randomized controlled study was planned and 40 consecutive ankle fractures involving middle-sized (10-25%) posterior fragment were included. Posterior fragments in Group 1 were not fixated while Group 2 underwent posterior malleolus fixation. The patients were evaluated both functionally and radiologically at minimum 2-years. RESULTS Demographics and fracture type distributions were similar between the groups. Despite the slightly better functional outcome in Group 2, no significant functional or radiological outcome difference could be detected. Articular step-off> 1 mm was more common in Group 1 (p = 0.04) and the patients with articular step-off showed significantly worse functional outcome in all functional parameters (p < 0.05). Radiological and functional outcome parameters were positively correlated when all patients were evaluated together. Lateral radiographs caused an overestimation in the size of posterior fragment compared to CT (p < 0.001). CONCLUSION Although there was a slightly better clinical outcome in patients with fixed posterior fragments, it was not significant at short to mid-term follow-up. However, posterior fragment fixation contributed to functional outcomes by decreasing the incidence of articular step-off> 1 mm, which was found to be a negative prognostic factor. LEVEL OF EVIDENCE Level I; prospective randomized controlled study.
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Affiliation(s)
- Bedri Karaismailoglu
- Istanbul University - Cerrahpasa, Cerrahpasa Medical Faculty, Department of Orthopaedics and Traumatology, Istanbul, Turkey; Foot & Ankle Research and Innovation Laboratory (FARIL), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, MA, USA; CAST (Cerrahpasa Research, Simulation and Design Laboratory), Istanbul University-Cerrahpasa, Istanbul, Turkey.
| | - Onur Yıldırım
- Istanbul University - Cerrahpasa, Cerrahpasa Medical Faculty, Department of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Lercan Aslan
- Koc University Hospital, Department of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Necip Selcuk Yontar
- Nisantasi Orthopaedics Center, Foot and Ankle Surgery Clinic, Istanbul, Turkey
| | - Mehmet Fatih Guven
- Istanbul University - Cerrahpasa, Cerrahpasa Medical Faculty, Department of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Gokhan Kaynak
- Istanbul University - Cerrahpasa, Cerrahpasa Medical Faculty, Department of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Tahir Ogut
- Nisantasi Orthopaedics Center, Foot and Ankle Surgery Clinic, Istanbul, Turkey
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