A case–control study of surgical site infection following operative fixation of fractures of the ankle in a large UK trauma unit

Korim, M.T.; Payne, Richard J.; Bhatia, Maneesh

doi:10.1302/0301-620x.96b5.33143

Cited by 68 publications

(69 citation statements)

References 25 publications

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“…Both superficial and deep infections result in lower functional scores as assessed using the Olreud and Molander Ankle Score. 9 Our study demonstrated that on follow up at 6 weeks, 11 out of 45 patients had persistent swelling and residual pain, 9 patients had only residual pain and 6 patients had only persistent swelling. One patient was found to have loss of reduction, which was attributed to early weight bearing against medical advice.…”

Section: Inferencesupporting

confidence: 47%

Functional Outcome Following Operative Treatment of Ankle Fractures

D'Almeida¹,

Thomas²,

Devasia³

et al. 2015

jemds

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Section: Inferencesupporting

confidence: 47%

Functional Outcome Following Operative Treatment of Ankle Fractures

D'Almeida¹,

Thomas²,

Devasia³

et al. 2015

jemds

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“…However, the results of this study open up the option to investigate the applicability of CCC to patients with these diseases, as there is a high risk of harms after surgical treatment. 27,114,115 The primary end point at 6 months could be criticised as being too early for definitive assessment of outcome. A recent systematic review and meta-analysis, 9 however, demonstrated that improvement of patient outcomes from all previously published studies of ankle function outcomes after ankle fractures showed that improvement plateaued by 6 months and, therefore, supports this as the definitive assessment point.…”

Section: External Validity and Generalisabilitymentioning

confidence: 99%

The Ankle Injury Management (AIM) trial: a pragmatic, multicentre, equivalence randomised controlled trial and economic evaluation comparing close contact casting with open surgical reduction and internal fixation in the treatment of unstable ankle fractures in patients aged over 60 years

Keene

Mistry

Nam

et al. 2016

Health Technol Assess

126

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BackgroundClose contact casting (CCC) may offer an alternative to open reduction and internal fixation (ORIF) surgery for unstable ankle fractures in older adults.ObjectivesWe aimed to (1) determine if CCC for unstable ankle fractures in adults aged over 60 years resulted in equivalent clinical outcome compared with ORIF, (2) estimate cost-effectiveness to the NHS and society and (3) explore participant experiences.DesignA pragmatic, multicentre, equivalence randomised controlled trial incorporating health economic evaluation and qualitative study.SettingTrauma and orthopaedic departments of 24 NHS hospitals.ParticipantsAdults aged over 60 years with unstable ankle fracture. Those with serious limb or concomitant disease or substantial cognitive impairment were excluded.InterventionsCCC was conducted under anaesthetic in theatre by surgeons who attended training. ORIF was as per local practice. Participants were randomised in 1 : 1 allocation via remote telephone randomisation. Sequence generation was by random block size, with stratification by centre and fracture pattern.Main outcome measuresFollow-up was conducted at 6 weeks and, by blinded outcome assessors, at 6 months after randomisation. The primary outcome was the Olerud–Molander Ankle Score (OMAS), a patient-reported assessment of ankle function, at 6 months. Secondary outcomes were quality of life (as measured by the European Quality of Life 5-Dimensions, Short Form questionnaire-12 items), pain, ankle range of motion and mobility (as measured by the timed up and go test), patient satisfaction and radiological measures. In accordance with equivalence trial US Food and Drug Administration guidance, primary analysis was per protocol.ResultsWe recruited 620 participants, 95 from the pilot and 525 from the multicentre phase, between June 2010 and November 2013. The majority of participants, 579 out of 620 (93%), received the allocated treatment; 52 out of 275 (19%) who received CCC later converted to ORIF because of loss of fracture reduction. CCC resulted in equivalent ankle function compared with ORIF at 6 months {OMAS 64.5 points [standard deviation (SD) 22.4 points] vs. OMAS 66.0 points (SD 21.1 points); mean difference –0.65 points, 95% confidence interval (CI) –3.98 to 2.68 points; standardised effect size –0.04, 95% CI –0.23 to 0.15}. There were no differences in quality of life, ankle motion, pain, mobility and patient satisfaction. Infection and/or wound problems were more common with ORIF [29/298 (10%) vs. 4/275 (1%)], as were additional operating theatre procedures [17/298 (6%) vs. 3/275 (1%)]. Malunion was more common with CCC [38/249 (15%) vs. 8/274 (3%);p < 0.001]. Malleolar non-union was lower in the ORIF group [lateral: 0/274 (0%) vs. 8/248 (3%);p = 0.002; medial: 3/274 (1%) vs. 18/248 (7%);p < 0.001]. During the trial, CCC showed modest mean cost savings [NHS mean difference –£644 (95% CI –£1390 to £76); society mean difference –£683 (95% CI –£1851 to £536)]. Estimates showed some imprecision. Incremental quality-adjusted life-years following CCC were no different from ORIF. Over common willingness-to-pay thresholds, the probability that CCC was cost-effective was very high (> 95% from NHS perspective and 85% from societal perspective). Experiences of treatments were similar; both groups endured the impact of fracture, uncertainty regarding future function and the need for further interventions.LimitationsAssessors at 6 weeks were necessarily not blinded. The learning-effect analysis was inconclusive because of limited CCC applications per surgeon.ConclusionsCCC provides a clinically equivalent outcome to ORIF at reduced cost to the NHS and to society at 6 months.Future workLonger-term follow-up of trial participants is under way to address concerns over potential later complications or additional procedures and their potential to impact on ankle function. Further study of the patient factors, radiological fracture patterns and outcomes, treatment responses and prognosis would also contribute to understanding the treatment pathway.Trial registrationCurrent Controlled Trials ISRCTN04180738.FundingThe National Institute for Health Research Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 20, No. 75. See the NIHR Journals Library website for further project information. This report was developed in association with the National Institute for Health Research Oxford Biomedical Research Unit funding scheme. The pilot phase was funded by the AO Research Foundation.

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“…A large population-based study conducted by Soohoo et al 2009 [22] noted that open injuries, diabetes, old age, Weber C were strong risk factors predicting a complicated short-term postoperative course [24][25] . [26] .…”

Section: Patients At Higher Risk For Postoperative Complicationsmentioning

confidence: 99%

A retrospective study of functional outcome of surgically managed malleolar fracture at the ankle joint by subjective, objective and radiological assessment

Sultanpurkar¹,

Haranadh²,

Vikram³

et al. 2017

Int. J. Orthop. Sci.

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Objective: To study the functional outcome of surgically managed malleolar fractures at ankle and to assess the results of complication. Introduction: Ankle fracture is a common injury with potentially significant morbidity associated with it. Regardless of the method of the intervention, main goal is to restore normal anatomy. Complications associated with both conservative and operative management are an important consideration in decision making. Patient selection is very important in deciding the type of management. This paper provides an update to surgical management of ankle fractures. Methodology: Medical records of 96 patients were studied and data was collected which includes the demographic data, fracture details, intraoperative and postoperative details. Then patients were called up for follow-up. The functional outcome of these patients was assessed subjectively using OLERUD MOLANDER ANKLE SCORE (OMA) score. Objective and radiological outcome was assessed using cedell's criteria. Results: Among the 96 patients we achieved excellent and good subjective results in 60 (62.5%) patients; Good objective result in 72 (75%) patients; Good radiographic results in 80 (83.4%) patients. In our study, patients with unimalleolar fractures had the best outcome. Trimalleolar fractures had the worst outcome. Bimalleolar fracture had intermediate outcome. With regards to lateral malleolar fracture fixation modality, patients with rush nail achieved good to fair radiological and objective outcome with no poor outcomes With regards to medial malleolar fracture fixation modality, patients with Tension band achieved good objective and radiological outcome and there were no poor outcomes. In patients with malleolar screw fixation 62.5 % patients achieved good objective and 75 % patients achieved good radiological outcome. Patients with complications has poorer outcome. In patients with superficial infection the outcome was poorer.

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A case–control study of surgical site infection following operative fixation of fractures of the ankle in a large UK trauma unit

Cited by 68 publications

References 25 publications

Functional Outcome Following Operative Treatment of Ankle Fractures

Functional Outcome Following Operative Treatment of Ankle Fractures

The Ankle Injury Management (AIM) trial: a pragmatic, multicentre, equivalence randomised controlled trial and economic evaluation comparing close contact casting with open surgical reduction and internal fixation in the treatment of unstable ankle fractures in patients aged over 60 years

A retrospective study of functional outcome of surgically managed malleolar fracture at the ankle joint by subjective, objective and radiological assessment

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