American College of Foot and Ankle Surgeons® Clinical Consensus Statement: Perioperative Management

Meyr, Andrew J.; Mirmiran, Roya; Naldo, Jason; Sachs, Brett D.; Shibuya, Naohiro

doi:10.1053/j.jfas.2016.10.016

Cited by 18 publications

(20 citation statements)

References 390 publications

(464 reference statements)

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“…Routine radiographs might resemble low-value care, and omitting them might lead to increased efficiency for the health care system. The American College of Foot and Ankle Surgeons released a consensus statement discouraging the use of routine radiographs to monitor fracture, osteotomy, and arthrodesis healing without a clinical indication in the foot and ankle [ 37 ]. However, to date, prospective evidence to support this claim is lacking.…”

Section: Discussionmentioning

confidence: 99%

The value of radiography in the follow-up of extremity fractures: a systematic review

Gerven

Rubinstein²,

Nederpelt

et al. 2018

Arch Orthop Trauma Surg

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BackgroundThe added value of routine radiography in the follow-up of extremity fractures is unclear. The aim of this systematic review was to create an overview of radiography use in extremity fracture care and the consequences of these radiographs for the treatment of patients with these fractures.Materials and methodsStudies were included if they reported on the use of radiography in the follow-up of extremity fractures and on its influence on treatment strategy, clinical outcome, or complications. A comprehensive search of electronic databases (i.e., PubMed, Embase, and Cochrane) was performed to identify relevant studies. Methodological quality was assessed with the Newcastle–Ottawa scale for cohort studies. Level of evidence was assessed using GRADE. The search, quality appraisal, and data extraction were performed independently by two researchers.ResultsEleven studies were included. All studies were retrospective cohorts. Of these, only two used a comparative design. Two of the included studies described fractures of both the upper and lower extremities, four studies concerned fractures of the lower extremity only, and five studies focused on fractures of the upper extremity. Pooling of data was not performed because of clinical heterogeneity. Eight studies reported on a change in treatment strategy related to radiography. Percentages ranged from 0 to 2.6%. The overall results indicated that radiographs in the follow-up of extremity fractures seldom alter treatment strategy, that the vast majority of follow-up radiographs are obtained without a clinical indication and that detection of a complication on a radiograph, in the absence of clinical symptoms, is unlikely. All included studies were regarded of a ‘very low’ level using GRADE.ConclusionsBased on current literature, the added value of routine radiography in the follow-up of extremity fractures seems limited. Results, however, should be interpreted with care, considering that available evidence is of a low level.Electronic supplementary materialThe online version of this article (10.1007/s00402-018-3021-y) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

The value of radiography in the follow-up of extremity fractures: a systematic review

Gerven

Rubinstein²,

Nederpelt

et al. 2018

Arch Orthop Trauma Surg

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“…A panel of experts convened by the American College of Foot and Ankle Surgeons, as part of a consensus group on perioperative management, could not reach a conclusion on whether vitamin D levels should be routinely tested before foot and ankle arthrodesis procedures for the aforementioned reasons (level of evidence: V). 82 In a consensus meeting of UK foot and ankle surgeons on the role of vitamin D and calcium in fractures, it was concluded that supplementation may reduce fracture risk and improve healing in high-risk or deficient groups, and they recommended that testing or direct supplementation might be appropriate in these patients (level of evidence: V). 83 The effects of routine supplementation in foot and ankle surgery, however, is yet to be determined, and most physicians do not routinely advise supplementation.…”

Section: Discussionmentioning

confidence: 99%

Vitamin D in the Foot and Ankle: A Review of the Literature

Malhotra¹,

Baggott²,

Livingstone³

2020

Journal of the American Podiatric Medical Association

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This manuscript reviews the role of Vitamin D and its deficiency in pathology of the foot and ankle. Vitamin D is an essential vitamin which targets a number of tissues and organs, and plays an important role in calcium homeostasis. Vitamin D deficiency is common, particularly at higher latitudes where there is reduced exposure to ultraviolet B radiation. The effects of Vitamin D deficiency have been extensively studied but only a small portion of the literature has focused on the foot and ankle. Most of the evidence regarding the foot and ankle consists of retrospective studies which cannot determine whether Vitamin D deficiency is in fact the cause for the pathologies being investigated. The available evidence suggests that insufficient levels of Vitamin D may result in an increased incidence of foot and ankle fractures. The effects of Vitamin D deficiency on fracture healing, bone marrow edema syndrome, osteochondral lesions of the talus, strength around the foot and ankle, tendon disorders, elective foot and ankle surgery, and other foot and ankle conditions are less clear. Based on the available evidence, we are unable to recommend routine testing or supplementation of Vitamin D in patients presenting with foot and ankle pathology. However, Vitamin D supplementation is cheap, safe and may be of benefit in patients at high risk of deficiency. When it is supplemented the evidence suggests calcium should be co-supplemented. Further high-quality research is needed into the effect of Vitamin D in the foot and ankle. Cost-benefit analyses of routine testing and / or supplementation of Vitamin D for foot and ankle pathology are also required.

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“…Other contraindications include patients with peripheral arterial bypass or vascular graft surgery secondary to the added risk of irreparable damage to the bypass or graft . Although these contraindications are generally accepted, and should be until strong evidence proves otherwise, the “American College of Foot and Ankle Surgeons Clinical Consensus Statement: Perioperative Management” reports there is insufficient literature to support them.…”

Section: Indications and Contraindicationsmentioning

confidence: 99%

Understanding and Optimizing Tourniquet Use During Extremity Surgery

Jensen¹,

Hicks²,

Labovitz³

2019

AORN Journal

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Tourniquet use during extremity surgery is commonplace and a relatively safe practice. The surgical team's knowledge of the patient history, proper assessment, and indications and contraindications for and risks of tourniquet use can prevent unwanted outcomes. Exploration of these critical areas reinforces perioperative nurses’ awareness and understanding of safe tourniquet use. Additionally, a review of the physiological effect of tourniquets on the skin, the body's response to local compression, the risk of vascular compromise, and the effect of the tourniquet on postoperative pain and swelling provides insight into AORN recommended practice guidelines. This article summarizes the indications and assessments for and risks of tourniquet use for patients during extremity surgery. An understanding of these topics can improve surgical outcomes and promote safe perioperative care.

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American College of Foot and Ankle Surgeons® Clinical Consensus Statement: Perioperative Management

Cited by 18 publications

References 390 publications

The value of radiography in the follow-up of extremity fractures: a systematic review

The value of radiography in the follow-up of extremity fractures: a systematic review

Vitamin D in the Foot and Ankle: A Review of the Literature

Understanding and Optimizing Tourniquet Use During Extremity Surgery

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