Postoperative Reoperations and Complications in 32,307 Ankle Fractures With and Without Concurrent Ankle Arthroscopic Procedures in a 5-Year Period Based on a Large U.S. Healthcare Database

Yasui, Youichi; Shimozono, Yoshiharu; Hung, Chun Wai; Marangon, Alberto; Wollstein, Adi; Gianakos, Arianna L.; Kennedy, John G.

doi:10.1053/j.jfas.2018.03.030

Cited by 13 publications

(5 citation statements)

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“…While early reoperation rates (within 12 months of index ORIF) are low, from 0.82% to 3.7% in most series, reports as high as 7.8% have been published. 1,5,26,31,42,48,56,60 Multiple previous studies have investigated the incidence of and risk factors associated with wound complications after operative treatment. 14,33,37,48,62 Similarly, work by Ovaska et al 42 identified technical errors leading to the need for acute revision.…”

Section: Introductionmentioning

confidence: 99%

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Risk Factors for Aseptic Revision of Operatively Treated Ankle Fractures

et al. 2021

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Background: Early revision rates within 12 months after ankle fracture open reduction internal fixation (AF-ORIF) are fairly low; however, they remain relevant given the volume of ankle fractures occurring annually. Understanding these rates is complex because reoperation due to technical or mechanical complications is typically reported alongside soft tissue–related problems such as symptomatic hardware, wound dehiscence, or infection. There are limited data identifying risk factors specifically for revision of ankle fracture fixation in the absence of soft tissue complications. Understanding variables that predispose to aseptic technical and mechanical failure without this confounder may provide insight and improve patient care. Methods: A retrospective cohort study was performed at 2 large academic medical centers. Research Patient Data Registry (RPDR) data available from 2002 to 2019 were used to identify patients who underwent aseptic revision of AF-ORIF within 12 months (n = 33). A control group (n = 100) was selected by identifying sequential patients who underwent AF-ORIF not requiring revision within 12 months. Multiple factors were recorded for all patients in both cohorts. Each fracture was also evaluated according to the Ankle Reduction Classification System (ARCS) of Chien et al,8 which categorizes biplanar talar displacement in relation to a central tibial plumb line into 1 of 3 grades: A (0-2 mm), B (3-10 mm), and C (>10 mm). Adapted from its original purpose of grading reduction quality, we applied ARCS to pre-reduction radiographs to assess initial fracture displacement. All variables collected were compared in univariate analysis. Variables that achieved significance in univariate comparisons were included as candidates for multivariable analysis. Results: Final multivariable logistic regression modeling demonstrated the following factors to independently predict the need for aseptic revision surgery: documented falls in the early postoperative period (aOR, 298; 95% CI, 15.4, 5759; P < .001), movement-altering disorders (aOR, 81.7; 95% CI, 4.12, 1620; P = .004), a nonanatomic mortise (medial clear space [MCS] > superior clear space [SCS]) on immediate postoperative imaging (aOR, 38.4; 95% CI, 5.53, 267; P < .001), initial coronal plane tibiotalar displacement >10 mm and sagittal plane tibiotalar dislocation (ARCS-C) (aOR vs ARCS-A, 25.8; 95% CI, 2.81, 237; P = .004), substance abuse (aOR, 15.7; 95% CI, 2.66, 92.8; P = .002), and polytrauma (aOR, 12.3; 95% CI, 2.02, 74.8; P = .006). Conclusion: In this investigation we found a notable increase in risk for revision surgery after AF-ORIF for patients who had one of the following: (1) falls in the early postoperative period, (2) movement-altering disorders, (3) a nonanatomic mortise (MCS > SCS) on immediate postoperative imaging, (4) more severe initial fracture displacement, (5) substance abuse, or (6) polytrauma. Identifying these factors may allow surgeons to better understand risk and counsel patients, and may serve as future targets for intervention aimed at improving patient safety and outcomes after ankle fracture ORIF. Level of Evidence: Level III, retrospective cohort study.

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Section: Introductionmentioning

confidence: 99%

“…Reoperation due to technical or mechanical complications is typically reported alongside soft tissue–related complications such as wound dehiscence or infection, which are statistically more common. 1,30,31,37,48,54,55,60…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Aseptic Revision of Operatively Treated Ankle Fractures

et al. 2021

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“…The variability of the results between both studies [ 12 , 32 ] might be due to the different diagnostic method utilised (arthroscopy vs MRI). MRI seems to overestimate the size/depth of CL and/or OCL [ 59 ]. However, there are limited data available in the literature comparing MRI and arthroscopy in the same population regarding diagnostic accuracy to detect CL and/or OCL.…”

Section: Discussionmentioning

confidence: 99%

Incidence of concomitant chondral/osteochondral lesions in acute ankle fractures and their effect on clinical outcome: a systematic review and meta-analysis

Darwich

Adam

Dally

et al. 2020

Arch Orthop Trauma Surg

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Introduction Despite successful osteosynthesis, some patients report residual symptoms after ankle fractures. One of the reasons behind the postoperative complaints might be traumatic concomitant chondral lesions (CL) and/or osteochondral lesions (OCL) within the ankle joint. The study aims to systematically review the incidence of CL and/or OCL in ankle fractures and to assess their effect on the clinical outcome. Materials and methods This work was conducted according to PRISMA checklists. A systematic literature search was performed using following keywords: “Ankle Fractures” OR “Trimalleolar Fracture” OR “Bimalleolar Fracture” OR “Maisonneuve fracture” OR “Malleolus Fracture” AND “Cartilage” OR “Cartilage Diseases” OR “Cartilage, Articular” OR “chondral” up to March 2020. The identified articles were analysed to determine the incidence of CL and/or OCL. Included studies in the meta-analysis assessed possible cartilage damage through arthroscopy or MRI immediately after traumatic ankle fractures and described the postoperative clinical outcome. Results The search identified a total of 111 publications; 19 described the incidence of CL and/or OCL after ankle fractures; six met the criteria to be included in the meta-analysis: five (n = 293) diagnosed CL and/or OCL through arthroscopy during ORIF and one study (n = 153) used preoperative MRI. The clinical outcome was evaluated in four studies (n = 177) using AOFAS score and in two (n = 269) using FAOS score. The mean incidence of arthroscopically detected CL and/or OCL was 65 ± 21% [95% CI 53.9 to 76.72]. The cumulative meta-analysis sample size comprised a total of 400 Patients (170 with and 230 without CL and/or OCL) available for a mean follow-up of 23.9 ± 11.5 months [95% CI 11.79 to 36.07]. The average age was 44.3 ± 5.5 years [95% CI 38.57 to 50.13]. The meta-analysis revealed a mean AOFAS score of 91.2 ± 4.8 [95% CI 83.53 to 98.93] with versus 94.4 ± 4.7 [95% CI 86.81 to 102.07] without CL and/or OCL (p = 0.15) and a mean FAOS score of 73.2 ± 11.31 [95% CI − 28.44 to 174.85] with versus 79.0 ± 18.4 [95% CI − 86.77 to 244.87] without CL and/or OCL (p = 0.18). Conclusions CL and/or OCL appear very frequently after ankle fractures. A tendency towards a favourable short- to mid-term clinical outcome was noticed in ankle fractures without CL and/or OCL, however without reaching statistical significance. Level of evidence Level I.

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“…11 Furthermore, additional arthroscopy apparently does not appear to increase the complication rate associated with ankle fracture surgery. 34 Despite these considerations, AORIF is far from being the standard of care. In a current analysis of 32,307 patients surgically treated for ankle fractures, only 1% received additional arthroscopy.…”

Section: Introductionmentioning

confidence: 99%

“…In a current analysis of 32,307 patients surgically treated for ankle fractures, only 1% received additional arthroscopy. 34 The number of studies comparing AORIF with ORIF is limited. 13 To the authors' knowledge, only 4 comparative studies have been published, all including patients with simple isolated fractures of either the fibula 12,29,31 or the medial malleolus 33 only.…”

Section: Introductionmentioning

confidence: 99%

Propensity Score–Matched Analysis of Arthroscopically Assisted Ankle Facture Treatment Versus Conventional Treatment

et al. 2020

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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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Postoperative Reoperations and Complications in 32,307 Ankle Fractures With and Without Concurrent Ankle Arthroscopic Procedures in a 5-Year Period Based on a Large U.S. Healthcare Database

Cited by 13 publications

References 36 publications

Risk Factors for Aseptic Revision of Operatively Treated Ankle Fractures

Risk Factors for Aseptic Revision of Operatively Treated Ankle Fractures

Incidence of concomitant chondral/osteochondral lesions in acute ankle fractures and their effect on clinical outcome: a systematic review and meta-analysis

Propensity Score–Matched Analysis of Arthroscopically Assisted Ankle Facture Treatment Versus Conventional Treatment

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