Category: Ankle; Trauma Introduction/Purpose: Torsional injury to the foot and ankle may result in high fibular fracture with disruption of the syndesmotic ligaments, interosseous membrane, and other associated injuries to medial, posterior structures of the ankle. High Fibular Fracture at the fibular neck is referred as Maisonneuve Fracture of Fibula (MFF). These injuries are often missed or misdiagnosed as ankle sprains. Most of the current classification consider MFF a variant of ankle fracture with disruption of syndesmosis and high fibular fracture {Lauge Hansen PER, AO C3, Weber type C}. Only a few articles have described associated injuries and surgical treatment outcomes. The study's primary aim is to evaluate the associated injuries of MFF and the outcomes of our treatment approach. Methods: All patients undergoing syndesmotic fixation (CPT 27829) at a large tertiary academic center from 2012-2020 were identified. In these 748 patients, patient radiographs were reviewed to identify patients with Maisonneuve fractures (AO-44C3). Medical records were reviewed for patient characteristics, energy information of original injury, operative variables, and complications. Radiographic reduction was assessed on standard radiograph with assessment of the tibiofibular clear space and tibiofibular overlap on AP and mortise views, talocrural angle, the medial clear space, shenton line, and fibular station. An abnormality in one of these parameters was considered an abnormal reduction. Patients were contact to complete PROMIS Physical function and Pain Interference postoperatively. A total of 24 patients with Maisonneuve fractures were identified and included in analysis. Eleven patients completed PROMIS outcomes measures for a response rate of 55%, as four patients were deceased or incarcerated at the time of survey. Results: The average age was 45.3 (16 SD) with a mean BMI of 31.3 (10.4 SD). Nineteen patients were male (79.2%) with only 5 females (20.8). The mechanism of injury was low energy in 16/24 patients (66.7%) leaving 8 (33.3%) patients with high energy mechanisms. In addition to the high fibular fracture, a total of 13 patients (54.2%) had a posterior malleolar fracture, 11 (45.8%) had a medial malleolar fracture, and 8 (33.3%) had a deltoid ligament injury. Seven patients (29.2%) received screw fixation compared to 14 patients (58.3%) with tightrope fixation. Three patients (12.5%) received both tightropes and screws. No patient developed wound complications, and two patients underwent reoperation. Abnormal reduction occurred in 5/24 patients (20.8%) at final clinical follow up. At a median of 20 months (25 IQR) postoperatively, the median PROMIS physical function and pain interference scores were 41.2 (13.0 IQR) and 52.8 (4.8 IQR), respectively. Conclusion: Maisonneuve fractures are an extremely rare ankle fracture variant with a diverse subset of injury patterns. Our results show the clinical outcomes of Maisonneuve fractures are largely satisfactory in terms of wound complications and intermediate term outcomes. While 21% of patients were determined to have abnormal reduction postoperatively, we are limited by the inherent difficulties of assessing syndesmosis on plain radiographs rather than advanced imaging. PROMIS outcome scores demonstrate Maisonneuve fractures patients are more impacted by loss of function than pain, but both are within a standard deviation of the population mean.
Category: Other Introduction/Purpose: Falls following orthopaedic surgery are a known entity in the healthcare field possessing significant patient morbidity and driving increased healthcare cost. The vast majority of studies have focused on the incidence and risk factors for postoperative falls in the inpatient setting, however, this is in direct contrast to shifts seen toward same-day outpatient orthopaedic surgery over the past decade. It is crucial to better understand the incidence and risk factors for falls in a mixed inpatient and outpatient model. Additionally, no study to date has examined the risk factors for falls after foot and ankle surgery. Methods: A total of 168 patients were administered a questionnaire and interviewed to investigate the incidence of postoperative falls. Patients completed surveys pertaining to fall history pre- and post-operatively, fall risks, current medical status, and use of an ambulatory assist device. Medical records were reviewed. Questionnaires and interviews were completed at 2 week and 6-week post-operative follow up visits. Factors found to be associated with postoperative falls in univariate analysis (p<.05) were included in a binary logistic regression model. Results: Full six-week follow-up was present in 138 patients. A total of 87 (63.0%) females and 51 (37.0%) males with a median age of 52 (21 IQR) and BMI of 32.4 (11 IQR) were included. The total fall incidence in the first six postoperative weeks was 29.7% (41 patients). In multivariate analysis, antidepressant use and VAS score at two weeks postoperatively were independently associated with falls OR 3.6 (95% CI 1.3 - 10.1) and OR 1.3 (95% CI 1.1 -1.5), respectively. The results of other variables included in the model were as follows: The Johns Hopkins Fall Risk Score OR 1.0 (95% CI.87-1.2), total number of medications excluding as needed OR.85 (95% CI.65-1.1), anticonvulsant use OR 1.8 (95% CI.67 - 5.0), and history of falls in the past six months preoperatively 1.6 (.95% CI.44 - 5.7). Conclusion: The high outpatient fall rate in foot and ankle surgery warrants awareness of risk factors. Antidepressant use has been associated with falls, but has not been established as a risk factor for postoperative falls. Surgeons should be aware of the risk of postoperative falls in this patient population. The postoperative VAS score at two weeks was also shown to be independently associated with falls. Adequate postoperative pain control is vital to minimize such falls. This study has identified antidepressant use and postoperative VAS score at two weeks as two independent risk factors for postoperative falls in foot and ankle surgery.
Category: Other Introduction/Purpose: Preoperative Patient-Reported Outcomes Measurement Information System (PROMIS) scores have been shown to be predictive of postoperative success in orthopedic foot and ankle patients. The purpose of this study was to determine if an association exists between pre-operative PROMIS scores and patients going to the emergency department (ED) in the first 60 days following their operation. Methods: PROMIS scores, including physical function (PF) and pain inference (PI), were collected from 290 patients prior to foot and ankle procedures. Patients with presence of ongoing infection were excluded. Electronic medical record (EMR) data was retrospectively gathered for each patient to determine if they visited the ED for any reason during the first 60 days following their operation. A Backward Stepwise Logistic Regression analysis was conducted for postoperative ED visits with p<0.1 in univariate analysis required for entry into the model. Results: The median age was 50.0 with an interquartile range (IQR) of 20.0, while the median BMI was 33.1 with an IQR of 11.6. In univariate analysis, Preoperative PROMIS PF and PI scores were significantly associated with ED visits within the first 60 days after surgery. Patients who visited the ED had lower preoperative PROMIS PF (median 34.9 (IQR 10.2)) and higher PROMIS PI (median 66.9 (IQR 9.1)) compared to patients who did not visit the ED, PROMIS PF (median 38.0 (IQR 10.2)) and PROMIS PI (63.6 (IQR 9.0)), respectively. In multivariate analysis, only PROMIS PF was associated with lower risk of ED visits OR 0.92 (95% CI.85-.99). Other factors independently associated with ED visits included non-traumatic surgical indication OR 3.7 (95% CI 1.1- 12.9), any pulmonary disease OR 4.2 (95% CI 1.4-12.8), ASA classification OR 4.4 (95% CI 1.3-14.9), and wound complications OR 10.2 (95% CI 2.6-39.9). Conclusion: Patients with lower PROMIS PF scores preoperatively were significantly more likely to visit the ED postoperatively. While all of the factors found to be associated with ED visits are not modifiable by the surgeon, preoperative PROMIS scores could quickly and easily be used to identify patients for potential interventions. This study demonstrates the potential of the PROMIS outcomes system outside of quantifying surgical outcomes. Further study is being conducted to investigate the optimal PROMIS PF cutoff for best identifying patients at risk for ED visits.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.