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Baumbach SF, Urresti-Gundlach M, Braunstein M, Borgmann L, Böcker W, Vosseller JT, Polzer H. Propensity Score-Matched Analysis of Arthroscopically Assisted Ankle Facture Treatment Versus Conventional Treatment. Foot Ankle Int 2021; 42:400-408. [PMID: 33327772 PMCID: PMC8056703 DOI: 10.1177/1071100720969609] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The aim of this study was to assess the prospective, longitudinal outcome after arthroscopically assisted open reduction and internal fixation (AORIF) and to compare the results with open reduction and internal fixation (ORIF) in complex ankle fractures. METHODS Acute, closed, bimalleolar equivalent, bimalleolar, or trimalleolar ankle fractures were included. The AORIF cohort was enrolled prospectively. The ORIF group was identified from a retrospective database. The same inclusion and exclusion criteria were applied. The only difference was the additional arthroscopy in the AORIF cohort. The patient-reported outcome measurement (PROM) following AORIF was assessed at 1 and 4 years of follow-up using the Olerud and Molander Ankle Score (OMAS) and Tegner activity scale (TAS). The AORIF cohort was propensity score matched (nearest-neighbor matching) to the ORIF database. The OMAS and Foot and Ankle Ability Measure (FAAM) were compared between the resulting groups. Nonparametric statistics were applied; values are presented as median (interquartile range). Twenty-six AORIF patients had a prospective 4-year follow-up. RESULTS No significant differences (1 year vs 4 years) were identified for the OMAS (90 [10] vs 90 [11]) and TAS (4 [2] vs 5 [2]). The severity of the cartilage lesions (International Cartilage Repair Society [ICRS] grade <4 vs ICRS of 4) had no significant influence on the PROMs. Twenty-five patients per cohort (AORIF vs ORIF) were matched. The OMAS (90 [13] vs 75 [40]; P = .008) and FAAM Activities of Daily Living (ADL; 96 [11] vs 88 [30]; P = .034) revealed significantly better outcomes for AORIF. More patients in the AORIF cohort returned to sport (96% vs 77%; P = .035), with a higher FAAM Sports score (88 [37] vs 56 [47]; P = .008). CONCLUSION AORIF for complex ankle fractures led to consistently good to excellent results. The propensity score-matched analysis revealed a significantly better outcome 4 years after surgery for AORIF compared with ORIF. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Sebastian F. Baumbach
- Department of General, Trauma and Reconstructive Surgery, University Hospital, LMU Munich, Germany
| | - Marcel Urresti-Gundlach
- Department of General, Trauma and Reconstructive Surgery, University Hospital, LMU Munich, Germany
| | - Mareen Braunstein
- Department of General, Trauma and Reconstructive Surgery, University Hospital, LMU Munich, Germany
| | - Lars Borgmann
- Center for Higher Education, TU Dortmund University, Dortmund, Germany
| | - Wolfgang Böcker
- Department of General, Trauma and Reconstructive Surgery, University Hospital, LMU Munich, Germany
| | - J. Turner Vosseller
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Hans Polzer
- Department of General, Trauma and Reconstructive Surgery, University Hospital, LMU Munich, Germany,Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA,Hans Polzer, MD, Department of General, Trauma and Reconstructive Surgery, Munich University Hospital, Ludwig-Maximilians-University (LMU), Nussbaumstr. 20, Munich, 80336, Germany.
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Braunstein M, Baumbach SF, Urresti-Gundlach M, Borgmann L, Böcker W, Polzer H. Arthroscopically Assisted Treatment of Complex Ankle Fractures: Intra-articular Findings and 1-Year Follow-Up. J Foot Ankle Surg 2020; 59:9-15. [PMID: 31882154 DOI: 10.1053/j.jfas.2019.05.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 03/05/2019] [Accepted: 05/11/2019] [Indexed: 02/03/2023]
Abstract
Especially after complex ankle fractures, patients regularly suffer from residual symptoms, presumably due to occult intra-articular injuries. The aim of this study was to evaluate the intra-articular lesions, identify fractures specifically at risk for these, and assess the results after arthroscopically assisted open reduction and internal fixation of complex ankle fractures after 1 year. The primary outcome was the American Orthopedic Foot and Ankle Society (AOFAS) hindfoot score. Secondary outcome parameters were the Olerud and Molander Ankle Score (OMAS), Tegner activity scale, arthroscopic findings, functional assessment, and complications. Thirty-two patients (56% female) were enrolled. Chondral lesions were detected in 91%. Full-thickness lesions treated by microfracturing were observed in 0% of unimalleolar, 43% of bimalleolar, and 40% of trimalleolar fractures. After 1 year, the median (interquartile range) AOFAS was 94 (9) and OMAS was 90 (10) for all patients. When analyzing factors possibly influencing the outcome, age, sex, smoking, grading for surgical procedures according to the American Society of Anesthesiologists, fracture type (uni-, bi-, or trimalleolar), severity of chondral lesions graded according to the International Cartilage Repair Society (grade <4 versus grade 4), and syndesmotic instability had no significant influence on the outcome. The only variable significantly influencing the AOFAS (p = .004) and OMAS (p < .001) was body mass index (BMI; rs = -0.522 and -0.606, respectively), with a higher BMI resulting in inferior outcome scores. Complications were observed in 3 patients, 2 with superficial skin necrosis at the posterolateral incision and 1 nonunion of the medial malleolus. Taken together, these data show that intra-articular injuries were common in ankle fractures. Bi- and trimalleolar fractures were particularly at risk for full-thickness lesions. A higher BMI tended to result in inferior outcome scores. Arthroscopically assisted open reduction and internal fixation led to good to excellent results in all but 1 patient.
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Affiliation(s)
- Mareen Braunstein
- Associate Registrar, Department of General, Trauma and Reconstructive Surgery, Munich University Hospital, Munich, Germany
| | - Sebastian F Baumbach
- Surgeon, Associate Professor, Department of General, Trauma and Reconstructive Surgery, Munich University Hospital, Munich, Germany
| | - Marcel Urresti-Gundlach
- Associate Registrar, Department of General, Trauma and Reconstructive Surgery, Munich University Hospital, Munich, Germany
| | - Lars Borgmann
- Data Scientist, Center for Higher Education, TU Dortmund University, Dortmund, Germany
| | - Wolfgang Böcker
- Surgeon, Professor, Department of General, Trauma and Reconstructive Surgery, Munich University Hospital, Munich, Germany
| | - Hans Polzer
- Surgeon, Associate Professor, Department of General, Trauma and Reconstructive Surgery, Munich University Hospital, Munich, Germany.
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Abstract
BACKGROUND Fractures of the fifth metatarsal base (5th MT) are common foot injuries, but their treatment remains a subject of debate. The aim was to assess the midterm outcome of functionally treated epi-metaphyseal fractures (Lawrence and Botte types I and II) of the 5th MT. METHODS This study was a longitudinal retrospective database study with prospective follow-up. Included were all patients with an acute, isolated fracture to the 5th MT base (types I and II). All patients were treated functionally: weightbearing as tolerated without immobilization. Fracture types and fracture characteristics (displacement <2 mm/>2 mm, articular involvement, number of fragments) were assessed retrospectively. Patient-reported outcome measures (PROMs) including the visual analog scale for foot and ankle (VAS FA) and the quality-of-life score (QoL) SF-12 were collected prospectively at 2- and 5-year follow-up. Out of 95 patients, 43 patients (45%) were included with a median follow-up of 5.7 (1.5) years. RESULTS For both the VAS FA and SF-12, excellent scores were observed. For 30 patients (77%), longitudinal 2- and 5-year follow-up was available. No significant longitudinal changes could be observed for the VAS FA and SF-12. For both time points, neither fracture type nor characteristics significantly influenced any outcome parameter assessed. CONCLUSION Functional treatment by full weightbearing and free range of motion led to excellent 5-year results for both type I and II fractures. Neither fracture location nor characteristics had a significant influence on the 5-year PROMs. LEVEL OF EVIDENCE Level III, comparative study.
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Affiliation(s)
- Sebastian F. Baumbach
- Department of General, Trauma and Reconstructive Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Marcel Urresti-Gundlach
- Department of General, Trauma and Reconstructive Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Wolfgang Böcker
- Department of General, Trauma and Reconstructive Surgery, University Hospital, LMU Munich, Munich, Germany
| | - J. Turner Vosseller
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Hans Polzer
- Department of General, Trauma and Reconstructive Surgery, University Hospital, LMU Munich, Munich, Germany,Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA,Hans Polzer, MD, Department of General, Trauma and Reconstructive Surgery, Munich University Hospital, Ludwig-Maximilians-University (LMU), Nussbaumstr. 20, Munich, 80336, Germany.
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Urresti-Gundlach M, Tolks D, Kiessling C, Wagner-Menghin M, Härtl A, Hege I. Do virtual patients prepare medical students for the real world? Development and application of a framework to compare a virtual patient collection with population data. BMC Med Educ 2017; 17:174. [PMID: 28938884 PMCID: PMC5610434 DOI: 10.1186/s12909-017-1013-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 09/14/2017] [Indexed: 05/16/2023]
Abstract
BACKGROUND An important aspect of virtual patients (VPs), which are interactive computer-based patient scenarios, is authenticity. This includes design aspects, but also how a VP collection represents a patient population and how a patient is presented in a VP scenario. Therefore, our aim was to analyze VP scenarios integrated into the combined internal medicine and surgery curriculum at the University of Munich (LMU) and compare the results with data from the population in Germany. METHOD We developed a coding framework with four main categories: patient data, patient representation, diagnoses, and setting. Based on the framework we analyzed 66 VP and compared the results with data from the German healthcare system. RESULTS Especially in the categories of patient data and patient representation, the VPs presented an unrealistic image of the real world; topics such as unemployment, disability, or migration background were almost non-existent. The diagnoses of the VPs and the onset of diseases were comparable with the healthcare data. CONCLUSIONS An explanation for the lack of representativeness of the patient data and representation might be a trend to create VPs based on fictional patient stories with VP authors trying to minimize complexity and cognitive load for the students. We suggest raising awareness among VP authors concerning personalized representations of patients without overwhelming their students. Our framework can support educators to assess the authenticity and diversity of a VP collection.
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Affiliation(s)
- M. Urresti-Gundlach
- Institute for Medical Education, University Hospital of LMU Munich, Munich, Germany
| | - D. Tolks
- Institute for Medical Education, University Hospital of LMU Munich, Munich, Germany
| | - C. Kiessling
- Institute for Medical Education, University Hospital of LMU Munich, Munich, Germany
- Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | | | - A. Härtl
- Institute for Medical Education, University Hospital of LMU Munich, Munich, Germany
| | - I. Hege
- Institute for Medical Education, University Hospital of LMU Munich, Munich, Germany
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