JournalTOCs

Foot & Ankle Orthopaedics
Number of Followers: 3

This is an Open Access Journal

Open Access journal
ISSN (Print) 2473-0114 - ISSN (Online) 2473-0114
Published by Sage Publications

[1174 journals]

FAO Essential Reviews, Part V: Focus on The Ankle
- Authors: Charles Saltzman
  Abstract: Foot & Ankle Orthopaedics, Volume 7, Issue 3, July-September 2022.
  
  Citation: Foot & Ankle Orthopaedics
  PubDate: 2022-08-06T12:15:12Z
  DOI: 10.1177/24730114221114960
  Issue No: Vol. 7, No. 3 (2022)
Effect of the Reversed L-Shaped Osteotomy on the Round Sign: Not All
Hallux Valgus Deformities May Need Proximal Derotation to Correct the
Radiographic Appearance of Metatarsal Pronation
- Authors: Lizzy Weigelt, Linda Wild, Elin Winkler, Carlos Torrez, Thorsten Jentzsch, Stephan H. Wirth
  Abstract: Foot & Ankle Orthopaedics, Volume 7, Issue 3, July-September 2022.
  Background:Metatarsal pronation has been claimed to be a risk factor for hallux valgus recurrence. A rounded shape of the lateral aspect of the first metatarsal head has been identified as a sign of persistent metatarsal pronation after hallux valgus correction. This study investigated the derotational effect of a reversed L-shaped (ReveL) osteotomy combined with a lateral release to correct metatarsal pronation. The primary hypothesis was that most cases showing a positive round sign are corrected by rebalancing the metatarsal-sesamoid complex. We further assumed that the inability to correct the round sign might be a risk factor for hallux valgus recurrence.Methods:We retrospectively evaluated 266 cases treated with a ReveL osteotomy for hallux valgus deformity. The radiologic measurements were performed on weightbearing foot radiographs preoperatively, at an early follow-up (median, 6.2 weeks), and the most recent follow-up (median, 13 months). Univariate and multivariate logistic regression analyses identified risk factors for hallux valgus recurrence (hallux valgus angle [HVA] ≥ 20 degrees).Results:A preoperative positive radiographic round sign was present in 40.2% of the cases, of which 58.9% turned negative after the ReveL osteotomy (P < .001). Hallux valgus recurred in 8.6%. Risk factors for recurrence were a preoperative HVA >30 degrees (odds ratio [OR] = 5.3, P < .001), metatarsus adductus (OR = 4.0, P = .004), preoperative positive round sign (OR = 3.3, P = .02), postoperative HVA >15 degrees (OR = 74.9; P < .001), and postoperative positive round sign (OR = 5.3, P = .008). Cases with a positive round sign at the most recent follow-up had a significantly higher recurrence rate than those with a negative round sign (22.7% vs 5.9%, P < .001).Conclusion:The ReveL osteotomy corrected a positive round sign in 58.9%, suggesting that not all hallux valgus deformities may need proximal derotation to negate the radiographic appearance of the round sign. A positive round sign was found to be an independent risk factor for hallux valgus recurrence. Further 3-dimensional analyses are necessary to better understand the effects and limitations of distal translational osteotomies to correct metatarsal pronation.Level of Evidence:Level IV, case series.
  Citation: Foot & Ankle Orthopaedics
  PubDate: 2022-08-06T04:50:00Z
  DOI: 10.1177/24730114221115697
  Issue No: Vol. 7, No. 3 (2022)
Initial Impact of the COVID-19 Pandemic on a US Orthopaedic Foot and Ankle
Clinic
- Authors: Nabil Mehta, Edward S. Hur, Joseph Michalski, Ashlyn A. Fitch, Arash J. Sayari, Daniel D. Bohl, George B. Holmes
  Abstract: Foot & Ankle Orthopaedics, Volume 7, Issue 3, July-September 2022.
  Background:In the United States, the COVID-19 pandemic led to a nationwide quarantine that forced individuals to adjust their daily activities, potentially impacting the burden of foot and ankle disease. The purpose of this study was to compare diagnoses made in an orthopaedic foot and ankle clinic during the shelter-in-place period of the COVID-19 pandemic to diagnoses made during the same months of the previous year.Methods:A retrospective review of new patients presenting to the clinics of 4 fellowship-trained orthopaedic foot and ankle surgeons in a major United States city was performed. Patients in the COVID-19 group presented between March 22 and July 1, 2020, during the peak of the quarantine for this city. Patients in the control group presented during the same period of 2019. Final diagnosis, chronicity of symptoms (acute: ≤1 month), and mechanism of disease were compared between groups.Results:A total of 1409 new patient visits were reviewed with 449 visits in the COVID-19 group and 960 visits in the control group. The COVID-19 group had a significantly higher proportion of ankle fractures (8.7% vs 5.4%, P = .020) and stress fractures (4.2% vs 2.2%, P = .031), but a smaller proportion of Achilles tendon ruptures (0.7% vs 2.5%, P = .019). The COVID-19 group had a higher proportion of acute injuries (35.4% vs 23.5%, P < .001).Conclusion:There was a shift in prevalence of pathology seen in the foot and ankle clinic during the COVID-19 pandemic, which may reflect the adoption of different activities during the quarantine period and reluctance to present for evaluation of non-urgent injuries.Level of Evidence:Level III, retrospective cohort study.
  Citation: Foot & Ankle Orthopaedics
  PubDate: 2022-08-03T06:54:01Z
  DOI: 10.1177/24730114221115689
  Issue No: Vol. 7, No. 3 (2022)
Talar Middle Facet Fracture: A Report of 2 Cases
- Authors: Marcos Hideyo Sakaki, Kenji Maeda Missima, Nacime Salomão Barbachan Mansur, Cesar de Cesar Netto
  Abstract: Foot & Ankle Orthopaedics, Volume 7, Issue 3, July-September 2022.
  
  Citation: Foot & Ankle Orthopaedics
  PubDate: 2022-08-03T06:53:01Z
  DOI: 10.1177/24730114221115684
  Issue No: Vol. 7, No. 3 (2022)
Complication Rates Are Similar Between Patients Aged 50 Years in Calcaneus
Fractures Treated With the Sinus Tarsi Approach
- Authors: Logan A. Reed, Alexander Mihas, Nicholas A. Andrews, Abhinav Agarwal, Kevin C. Wall, Clay A. Spitler, Michael D. Johnson
  Abstract: Foot & Ankle Orthopaedics, Volume 7, Issue 3, July-September 2022.
  Background:The sinus tarsi (ST) approach for calcaneus fractures has gained popularity in recent years with an increased interest in shifting to less invasive approaches for calcaneal fracture fixation allowing for adequate fixation if complications do not arise. Although the ST approach has gained acceptance as standard for calcaneus fracture fixation, the literature surrounding early complications rates based on age differences for this specific approach and pathology is lacking. The objective of this study was to determine if rates of complications based on age varied for patients undergoing open reduction and internal fixation (ORIF) of closed calcaneus fractures using the ST approach.Methods:A retrospective review of patients undergoing ORIF for closed calcaneus fractures from 2012 to 2020 was performed. Inclusion criteria were based on an age greater than 18 years, surgical management of a closed calcaneus fracture using a ST approach, requirement of a preoperative computed tomographic scan, and a minimum of 180 days’ follow-up. Patients were divided into 2 groups: those aged 50 years.Results:A total of 196 fractures were included with 114 fractures in the 50-year age group. Mean age was 34.2 and 59.7 years in the younger and older groups, respectively. The older group had similar rates of wound dehiscence (1.2% vs 4.4%, P = .204), superficial surgical site infection (1.2% vs 2.6%, P = .490), deep infection (9.8% vs 7.9%, P = .648), and nonunion (4.9% vs 3.5%, P = .633) compared with the younger group. Rates of 30-day readmission, unplanned reoperation, and symptomatic hardware were not significantly different. Postoperative Bohler and Gissane angles were not significantly different between both groups.Conclusion:Older patients with intraarticular calcaneus fractures treated via the ST approach maintain complication rates similar to those in younger individuals.Level of Evidence:Level III, retrospective study.
  Citation: Foot & Ankle Orthopaedics
  PubDate: 2022-08-03T06:52:00Z
  DOI: 10.1177/24730114221115678
  Issue No: Vol. 7, No. 3 (2022)
Comparing the 30-Day Complications Between Smokers and Nonsmokers
Undergoing Surgical Fixation of Ankle Fractures
- Authors: Bernard H. Sagherian, Jawad J. Hoballah, Hani Tamim
  Abstract: Foot & Ankle Orthopaedics, Volume 7, Issue 3, July-September 2022.
  Background:There have been conflicting reports regarding the effect of smoking on complications after surgical treatment of ankle fractures. This study aimed at identifying the complications for which smokers and subgroups of smokers are at a higher risk compared to nonsmokers when undergoing surgery for fixation of rotational ankle fractures.Methods:The American College of Surgeons National Surgical Quality Improvement Program data set from 2008 to 2019 was used to compare the 30-day wound, cardiac, renal, and infectious complications, related readmissions, and return to the operating room between the 2 cohorts.Results:Of 33 741 patients included, 25 642 (76.0%) were nonsmokers and 8099 (24.0%) were smokers. Multivariate analysis showed that smokers were at a higher risk for deep wound infection (OR 2.34, 95% CI 1.48-3.69, P < .001), wound dehiscence (OR 2.43, 95% CI 1.56-3.77, P < .001), related return to the operating room (OR 1.69, 95% CI 1.36-2.11, P < .001), and related readmissions (OR 1.67, 95% CI 1.32-2.09, P < .001). Smokers at an increased risk for deep infection included patients between 50 and 59 years (OR 5.75, 95% CI 1.78-18.5, P = .003), who were Black (OR 4.24, 95% CI 1.04-17.23, P = .044), who had body mass index (BMI) 35 to 39.9 (OR 3.73, 95% CI 1.46-9.50, P = .006), or operative times between 60 and 90 minutes (OR 3.64, 95% CI 1.79-7.39, P < .001). Smoker subgroups at a higher risk for wound dehiscence included patients between 50 and 59 years (OR 9.86, 95% CI 3.29-29.53, P < .001), with operative times between 90 and 120 minutes (OR 4.88, 95% CI 1.89-12.58, P < .001), with BMI 30 to 34.9 (OR 3.06, 95% CI 1.45-6.45, P = .003) and who underwent spinal/epidural anesthesia (OR 9.31, 95% CI 2.31-37.58, P = .002).Conclusion:Smokers were at an increased risk for deep wound infection, wound dehiscence, related reoperations, and related readmissions after ankle fracture surgery. Certain subgroups were at an even higher risk for these complications.Level of Evidence:Level III, retrospective cohort study.
  Citation: Foot & Ankle Orthopaedics
  PubDate: 2022-08-03T06:46:59Z
  DOI: 10.1177/24730114221115677
  Issue No: Vol. 7, No. 3 (2022)
Clinical and Radiologic Outcome of First Metatarsophalangeal Joint
Arthrodesis Using a Human Allogeneic Cortical Bone Screw
- Authors: Beatrice Hanslik-Schnabel, Daniel Flöry, Gudrun H. Borchert, Jakob E. Schanda
  Abstract: Foot & Ankle Orthopaedics, Volume 7, Issue 3, July-September 2022.
  Background:Different fixation techniques are established for first metatarsophalangeal joint (MTPJ) arthrodesis, including compression screws, plates, Kirschner wires, metal- and bioabsorbable screws as well as staples. The purpose of this study was to investigate and present first clinical and radiologic results using a novel human, allogeneic cortical bone screw for arthrodesis of the first MTPJ.Methods:Arthrodesis of the first MTPJ was performed in 31 patients with hallux rigidus. Percentage union and time to union were the first outcomes; visual analog scale for pain, hallux valgus angle (HVA), intermetatarsal angle, and American Orthopaedic Foot & Ankle Society (AOFAS) hallux score were secondary outcomes.Results:Median time to union was 89 days, and union was observed in all patients. There were 4 complications (2 osteolysis margin, 1 cystic brightening, and 1 severe swelling at the first follow-up) all of that resolved at last follow-up. Pain significantly decreased from visual analog scale 8.0 to 0.2 points (P < .0001). The HVA decreased from 30.4 to 10.2 degrees in the patient group with deformities. The total AOFAS score increased significantly from 48 to 87 (P < .0001).Conclusion:Primary and revision arthrodesis of hallux rigidus with the human, allogeneic cortical bone screw reveals satisfying results similar to clinical and radiologic outcomes of other surgical techniques. Within 1 year, the human, allogeneic cortical bone screw is fully remodeled to host bone.Level of Evidence:Level IV, retrospective case series without control group.
  Citation: Foot & Ankle Orthopaedics
  PubDate: 2022-07-30T04:57:01Z
  DOI: 10.1177/24730114221112944
  Issue No: Vol. 7, No. 3 (2022)
A Systematic Review and Meta-analysis of Total Ankle Arthroplasty or Ankle
Arthrodesis for Treatment of Osteoarthritis in Patients With Diabetes
- Authors: Arthur Tarricone, Allen Gee, Simon Chen, Karla De La Mata, Justin Muser, Wayne Axman, Prakash Krishnan, Vinayak Perake
  Abstract: Foot & Ankle Orthopaedics, Volume 7, Issue 3, July-September 2022.
  Background:End-stage ankle osteoarthritis often requires one of 2 major surgical procedures: total ankle arthroplasty or ankle arthrodesis. Although the gold standard has been arthrodesis, patients with diabetes represent a unique cohort that requires additional considerations because of their decreased mobility and risk factors for cardiovascular complications. The purpose of this study is to review odds of major and minor adverse events for patients with diabetes and patients without diabetes in both total ankle arthroplasty and ankle arthrodesis.Methods:A total of 14 articles published between 2010 and 2020 were included in this review. Databases included PubMed, Scopus, MEDLINE/Embase, and Cochrane Library. Key words included ankle arthroplasty, total ankle arthroplasty, ankle arthrodesis, and diabetes.Results:The total number of procedures was 26 287, comprising 13 830 arthroplasty and 12 457 arthrodesis procedures. There was a significant association between patients with diabetes treated with arthrodesis and major adverse events (odds ratio [OR] 1.880, 95% CI 1.279, 2.762), whereas no significant association was observed between patients with diabetes treated with arthroplasty and major adverse events (OR 1.106, 95% CI 0.871, 1.404).Conclusion:This meta-analysis suggests patients with diabetes to be at significantly higher risk for major and minor adverse events after undergoing ankle arthrodesis. However, it suggests no significant differences in major adverse events between patients with diabetes and patients without diabetes having undergone total ankle arthroplasty.Level of Evidence:Level III, systematic review and meta-analysis.
  Citation: Foot & Ankle Orthopaedics
  PubDate: 2022-07-26T07:10:15Z
  DOI: 10.1177/24730114221112955
  Issue No: Vol. 7, No. 3 (2022)
The Lateral Drawer Test: A New Clinical Test to Assess Mortise Instability
in Weber B Fibula Fractures
- Authors: John Z. Zhao, Eitan M. Ingall, Siddhartha Sharma, Soheil Ashkani-Esfahani, Yuzuru Sakakibara, Anthony Yi, Christopher P. Miller, John Y. Kwon
  Abstract: Foot & Ankle Orthopaedics, Volume 7, Issue 3, July-September 2022.
  Background:Assessment of mortise stability is paramount in determining appropriate management of ankle fractures. Although instability is readily apparent in bimalleolar or trimalleolar ankle fractures, determination of instability in the isolated Weber B fibula fracture often requires further investigation. Prior authors have demonstrated poor predictive value of physical examination findings such as tenderness, ecchymosis, and swelling with instability. The goal of this study is to test the validity of a new clinical examination maneuver, the lateral drawer test, against the gravity stress view (GSV) in a cohort of patients with Weber B fibula fractures. Secondary goals included assessing pain tolerability of the lateral drawer test, as well as testing interobserver reliability.Methods:Sixty-two patients presenting with isolated fibula fractures were prospectively identified by an orthopaedic nurse practitioner or resident. Three nonweightbearing radiographic views of the ankle as well as a GSV were obtained. Radiographs were not visualized before conducting the lateral drawer test. Two foot and ankle fellowship–trained orthopaedic surgeons performed and graded the lateral drawer test. Radiographs were then examined and medial clear space (MCS) was measured. Visual analog scale (VAS) pain scores were obtained before and after testing. The results of the lateral drawer test were compared with radiographic measurements of MCS on GSV. A cadaveric experiment was devised to assess interobserver reliability of the lateral drawer test.Results:Thirty (48%) of 62 consecutively enrolled patients demonstrated radiographic instability with widening of the MCS ≥5 mm on GSV. When correlated with MCS measurement, the lateral drawer test demonstrated a sensitivity of 83%, specificity of 97%, positive predictive value (PPV) of 96%, and negative predictive value (NPV) of 86%. There was a strong correlation between the lateral drawer test grade and amount of MCS widening (Spearman correlation ρ = 0.82, P < .005). Patients tolerated the maneuver well with an average increase of 0.7 on the VAS pain scale. Testing of 2 observers utilizing the cadaveric model demonstrated a Cohen’s Kappa coefficient of 0.7 indicating moderate interobserver agreement.Conclusion:The lateral drawer test demonstrates high sensitivity, specificity, PPV, and NPV with moderate interobserver reliability compared with the MCS on GSV in patients presenting with Weber B fibula fractures. Although further external validation is required, the lateral drawer test may offer an adjunct tool via physical examination to help determine mortise stability.Level of Evidence:Level II, Prospective Cohort Study.
  Citation: Foot & Ankle Orthopaedics
  PubDate: 2022-07-25T11:03:07Z
  DOI: 10.1177/24730114221112101
  Issue No: Vol. 7, No. 3 (2022)
Transmetatarsal Amputation Results in Higher Frequency of Revision Surgery
and Higher Ambulation Rates Than Below-Knee Amputation
- Authors: Angel Ordaz, Conner Trimm, Jason Pedowitz, Ian M. Foran
  Abstract: Foot & Ankle Orthopaedics, Volume 7, Issue 3, July-September 2022.
  Background:Selecting the level of amputation for patients with severe foot pathology can be challenging. The surgeon is sometimes confronted with an option between transmetatarsal amputation (TMA) and below-knee amputation (BKA). Recent studies have suggested that minor foot amputations have high revision rates and need for higher level of amputation. This study sought to compare the revision rates, need for higher level of amputation, postoperative ambulatory rate, and the demographic factors between these 2 operations.Methods:We retrospectively reviewed the records of patients undergoing either BKA or TMA at a single academic institution during an 8-year period. Demographic characteristics and medical history were collected and included in a binary logistic regression model to evaluate for independent predictors of needing revision surgery or needing higher-level amputation. Secondary outcomes included ambulatory status and wound status at last follow-up.Results:There was a total of 367 patients who underwent either BKA (n=293) or TMA (n=74).On binary logistic regression, the only significant independent predictor of needing revision surgery was undergoing TMA (odds ratio [OR] 2.30, CI 1.199-4.146, P = .011). The presence of PAD trended toward significance (OR 2.12, CI 0.99-4.493, P = .051). Similarly, significant independent predictors of needing higher level amputation were undergoing TMA (OR 4.117, CI 1.9-8.9, P < .001) and presence of PAD (OR 4.85, CI 1.59-14.85, P = .006). More TMA patients were ambulatory (56.8%) on last follow-up compared with BKA patients (30.9%).Conclusion:Transmetatarsal amputation has a higher risk of reoperation and need for revision amputation compared with below-knee amputation. Transmetatarsal amputation has a higher chance of returning patients to independent ambulation. Patients with peripheral arterial disease are at a higher risk of revision surgery and higher-level amputation with both operations.Level of Evidence:Level III, retrospective case review.
  Citation: Foot & Ankle Orthopaedics
  PubDate: 2022-07-21T10:34:02Z
  DOI: 10.1177/24730114221112938
  Issue No: Vol. 7, No. 3 (2022)
Translation of 3D Anatomy to 2D Radiographic Angle Measurements in the
Ankle Joint: Validity and Reliability
- Authors: Gwendolyn Vuurberg, Nazli Tümer, Inger Sierevelt, Johannes G. G. Dobbe, Robert Hemke, Jan Joost Wiegerinck, Mario Maas, Gino M. M. J. Kerkhoffs, Gabriëlle J. M. Tuijthof
  Abstract: Foot & Ankle Orthopaedics, Volume 7, Issue 3, July-September 2022.
  Background:The objective consisted of 2 elements, primarily to define 2 bone geometry variations of the ankle that may be of prognostic value on ankle instability and secondly to translate these bone variations from a 3D model to a simple 2D radiographic measurement for clinical use.Methods:The 3D tibial and talar shape differences derived from earlier studies were translated to two 2D radiographic parameters: the medial malleolar height angle (MMHA) and talar convexity angle (TCA) respectively to ensure clinical use. To assess validity, the MMHA and TCA were measured on 3D polygons derived from lower leg computed tomographic (CT) scans and 2D digitally reconstructed radiographs (DRRs) of these polygons. To assess reliability, the MMHA and TCA were measured on standard radiographs by 2 observers calculating the intraclass correlation coefficient (ICC).Results:The 3D angle measurements on the polygons showed substantial to excellent agreement with the 2D measurements on DRR for both the MMHA (ICC 0.84-0.93) and TCA (ICC 0.88-0.96). The interobserver reliability was moderate with an ICC of 0.58 and an ICC of 0.64 for both the MMHA and TCA, respectively. The intraobserver reliability was excellent with an ICC of 0.96 and 0.97 for the MMHA and the TCA, respectively.Conclusion:Two newly defined radiographic parameters (MMHA and TCA) are valid and can be assessed with excellent intraobserver reliability on standard radiographs. The interobserver reliability was moderate and indicates training is required to ensure uniformity in measurement technique. The current method may be used to translate more variations in bone shape prior to implementation in clinical practice.Level of Evidence:Level III, cohort study.
  Citation: Foot & Ankle Orthopaedics
  PubDate: 2022-07-21T10:34:02Z
  DOI: 10.1177/24730114221112945
  Issue No: Vol. 7, No. 3 (2022)
Early Radiographic Outcomes of Minimally Invasive Chevron Bunionectomy
Compared to the Modified Lapidus Procedure
- Authors: Elizabeth A. Cody, Kristin Caolo, Scott J. Ellis, A. Holly Johnson
  Abstract: Foot & Ankle Orthopaedics, Volume 7, Issue 3, July-September 2022.
  Background:Minimally invasive (MIS) bunion surgery has become increasingly popular. Although early reports on outcomes have been encouraging, no study to date has compared outcomes from the MIS chevron and Akin procedures to the modified Lapidus procedure. Our primary aim was to compare early radiographic outcomes of the MIS chevron and Akin osteotomies to those of the modified Lapidus procedure in patients with comparable deformities, and secondarily to compare clinical outcomes.Methods:Patients were retrospectively reviewed for inclusion from a prospectively collected foot and ankle registry. Patients were eligible if they underwent either the MIS bunionectomy or modified Lapidus procedure and had preoperative and minimum 5-month postoperative weightbearing radiographs. Forty-one patients who underwent MIS bunionectomy were matched to 41 patients who underwent Lapidus bunionectomy based on radiographic parameters. Demographics, radiographic parameters, complications, reoperations, and PROMIS scores were compared between groups.Results:Both groups achieved similar radiographic correction. There was no significant difference in pre- or postoperative PROMIS scores between groups. Procedure duration was significantly faster in the MIS group (P < .001). Bunion recurrence (hallux valgus angle ≥20 degrees) occurred in 1 MIS patient and 2 Lapidus patients, with all patients asymptomatic. The most common reason for reoperation was removal of hardware (4 patients in the MIS group, 2 patients in the Lapidus group).Conclusion:This is the first study to our knowledge to compare early radiographic outcomes between MIS bunionectomy and the modified Lapidus procedure in patients matched for bunion severity. We found that patients with similar preoperative deformities experience similar radiographic correction following MIS chevron and Akin osteotomies vs modified Lapidus bunionectomy. Further research is needed to investigate satisfaction differences between the procedures, longer-term outcomes, and which deformities are best suited to each procedure.Level of Evidence:Level III, Retrospective case control study.
  Citation: Foot & Ankle Orthopaedics
  PubDate: 2022-07-21T10:33:55Z
  DOI: 10.1177/24730114221112103
  Issue No: Vol. 7, No. 3 (2022)
Ankle Fusion After Prolonged Scedosporium boydii (Pseudallescheria boydii)
Infection Following Open Trimalleolar Fracture
- Authors: James Scully Jackson, Michael David Sandak, Leland McCluskey
  Abstract: Foot & Ankle Orthopaedics, Volume 7, Issue 3, July-September 2022.
  
  Citation: Foot & Ankle Orthopaedics
  PubDate: 2022-07-19T06:10:48Z
  DOI: 10.1177/24730114221112934
  Issue No: Vol. 7, No. 3 (2022)
Diabetic Kidney Disease Is Associated With Increased Complications
Following Operative Management of Ankle Fractures
- Authors: William S. Polachek, Hayden P. Baker, James S. Dahm, Jason A. Strelzow, Kelly K. Hynes
  Abstract: Foot & Ankle Orthopaedics, Volume 7, Issue 3, July-September 2022.
  Background:Diabetes mellitus and peripheral neuropathy are established risk factors for complications in operatively treated ankle fractures. Generally, the presence of peripheral neuropathy and diabetic nephropathy have been used as independent variables in studies of diabetic ankle fracture cohorts but are typically treated as binary risk factors. Our purpose was to quantify the effects of risk factors on complication rate specific to diabetic patients undergoing ankle fracture fixation.Methods:We identified 617 rotational ankle fractures treated operatively at a single academic medical center from 2010 to 2019, of which 160 were identified as diabetic. Of these, 91 ankle fractures in 90 diabetic patients met criteria for retrospective review of clinical and radiographic data. Criteria included perioperative laboratory studies, including glycated hemoglobin (HbA1c) and estimated glomerular filtration rate (eGFR), as well as follow-up radiographs in the electronic record. We defined complications in this surgical cohort as deep surgical site infection, unplanned return to the operating room, and failure of fixation. Logistic regression was performed and odds ratios (ORs) calculated.Results:The overall complication rate was 28.6% (26/91) in this cohort. Median follow-up was 29 weeks (range: 5-520 weeks). Mean perioperative HbA1c in patients who experienced postoperative complications was 7.6% (range: 5.1%-14.2%) compared with 7.8% (range: 5.6%-13.5%) who did not (P = .69). Diabetic patients with chronic kidney disease (eGFR
  Citation: Foot & Ankle Orthopaedics
  PubDate: 2022-07-19T06:07:28Z
  DOI: 10.1177/24730114221112106
  Issue No: Vol. 7, No. 3 (2022)