Cost-Utility Analyses in US Orthopaedic Foot and Ankle Surgery: A Systematic Review

Karhade, Aditya V.; Kwon, John Y.

doi:10.1177/1938640018782588

Foot & Ankle Specialist

2018

DOI: 10.1177/1938640018782588

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Cost-Utility Analyses in US Orthopaedic Foot and Ankle Surgery: A Systematic Review

Aditya V. Karhade

John Y. Kwon

Abstract: Level III: Systematic Review of level III studies.

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2020

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Cited by 3 publications

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References 29 publications

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“…1,2 Despite the rising popularity of suture button devices, surgical stabilization is most commonly achieved with fully threaded screws. 3-6 Several controversies including screw size, number of screws, and number of cortices engaged have been previously investigated in the literature. 4 Screw retention versus routine removal remains highly variable in clinical practice despite multiple investigations demonstrating no clinical, radiographic, or functional benefit to screw removal.…”

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Syndesmotic Screw Breakage May Be More Problematic Than Previously Reported: Increased Rates of Hardware Removal Secondary to Pain With Intraosseous Screw Breakage

Ibrahim

Velasco

et al. 2020

Foot & Ankle Specialist

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Background. The majority of retained syndesmotic screws will either loosen or break once the patient resumes weight-bearing. While evidence is limited, anecdotal experience suggests that intraosseous screw breakage may be problematic for some patients due to painful bony erosion. This study seeks to identify the incidence of intraosseous screw breakage, variables that may predict intraosseous screw breakage, and whether intraosseous screw breakage is associated with higher rates of implant removal secondary to pain. Methods. Five hundred thirty-one patients undergoing syndesmotic stabilization were screened, of which 43 patients (with 58 screws) experiencing postoperative screw breakage met inclusion criteria. Patient charts were retrospectively reviewed for demographic data, comorbidities, time to screw breakage, location of screw breakage, and implant removal. Several radiographic parameters were evaluated for their potential to influence the site of screw breakage. Results. Intraosseous screw breakage occurred in 32 patients (74.4%). Screw breakage occurred exclusively in the tibiofibular clear space in the remaining 11 instances (25.6%). Intraosseous screw breakage was significantly associated with eventual implant removal after breakage (P = .034). Screws placed further from the tibiotalar joint were at less risk for intraosseous breakage (odds ratio 0.818, P = .002). Screws placed at a threshold height of 20 mm or greater were more likely to break in the clear space (odds ratio 12.1, P = .002). Conclusion. Syndesmotic screw breakage may be more problematic than previously described. Intraosseous breakage was associated with higher rates of implant removal secondary to pain in this study. Placement of screws 20 mm or higher from the tibiotalar joint may decrease risk of intraosseous breakage. Levels of Evidence: Level III: Retrospective study

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confidence: 99%

Syndesmotic Screw Breakage May Be More Problematic Than Previously Reported: Increased Rates of Hardware Removal Secondary to Pain With Intraosseous Screw Breakage

Ibrahim

Velasco

et al. 2020

Foot & Ankle Specialist

Self Cite

View full text Add to dashboard Cite

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Cost-Effectiveness of Surgical Techniques in Hallux Valgus

Molloy

Heyes

2020

Foot and Ankle Clinics

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Modelling the cost-effectiveness of total knee arthroplasty: A systematic review

Kamaraj

Seah

et al. 2020

Journal of Orthopaedics

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Cost-Utility Analyses in US Orthopaedic Foot and Ankle Surgery: A Systematic Review

Abstract: Level III: Systematic Review of level III studies.

Cited by 3 publications

References 29 publications

Syndesmotic Screw Breakage May Be More Problematic Than Previously Reported: Increased Rates of Hardware Removal Secondary to Pain With Intraosseous Screw Breakage

Syndesmotic Screw Breakage May Be More Problematic Than Previously Reported: Increased Rates of Hardware Removal Secondary to Pain With Intraosseous Screw Breakage

Cost-Effectiveness of Surgical Techniques in Hallux Valgus

Modelling the cost-effectiveness of total knee arthroplasty: A systematic review

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