Chapter 53 Foot and Ankle Fractures and Surgery

2022 ◽  
Keyword(s):  
Ankle Fractures ◽  
Foot And Ankle

The Foot and Ankle Outcome Score (FAOS) During Early Recovery After Ankle Fracture

2021 ◽  
pp. 107110072110028
Author(s):  
Peter Larsen ◽  
Mohammed Al-Bayati ◽  
Rasmus Elsøe
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Ankle Fracture ◽  
Minimal Clinically Important Difference ◽  
Ankle Fractures ◽  
Foot And Ankle ◽  
Early Recovery ◽  
Clinically Important Difference ◽  
Test Retest Reliability

Background: Several patient-reported outcome measures (PROMs) are available for assessing the outcomes following ankle fractures. This study aimed to evaluate validity, reliability, and responsiveness and detect the minimal clinically important difference of the Foot and Ankle Outcome Score (FAOS) in patients with ankle fractures. Methods: The study design is a prospective cohort study, including all patients treated both conservatively and surgically following an ankle fracture (AO-43A/B/C). Content validity, test-retest reliability, responsiveness, and minimal clinically important difference were evaluated from 14 days to 3 months following the fracture. Results: The study population consisted of 52 females and 24 males. The mean age was 52.0 years (range, 15-75 years). The percentage of patients at 12 weeks reporting the 5 subscales at least somewhat relevant were pain, 77%; symptoms, 75%; activities of daily living (ADL), 64%; sport, 81%; and quality of life (QOL), 88%. High test-retest reliability of the FAOS questionnaire was observed. The interclass coefficients were 0.78, 0.77, 0.71, 0.73, and 0.74 for the pain, symptoms, ADL, sport, and QOL subscales, respectively. Responsiveness was evaluated with high effect size for the symptoms (0.83), ADL (1.19), sport (4.36), and QOL (2.12) subscales. The minimal clinically important difference of the FAOS was 14 (95% CI, 12-17). Conclusion: The FAOS during early recovery after ankle fracture has high reliability and validity. Level of Evidence: Level II, prospective cohort study

Effect of Chemical Thromboprophylaxis on the Rate of Venous Thromboembolism After Treatment of Foot and Ankle Fractures

2016 ◽  
Vol 37 (11) ◽  
pp. 1218-1224 ◽  
Author(s):  
Xin Zheng ◽  
Dong-Ya Li ◽  
Yufan Wangyang ◽  
Xing-Chen Zhang ◽  
Kai-Jin Guo ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Ankle Fractures ◽  
Foot And Ankle

Factors Affecting the Clinical Outcomes of Surgically Treated Ankle Fractures Associated with the Posterior Malleolar Fragment

2021 ◽  
Vol 111 (5) ◽  
Author(s):  
Mehmet Kuyumcu ◽  
Emre Bilgin ◽  
Hasan Bombacı
Keyword(s):  
Clinical Outcomes ◽  
Fragment Size ◽  
Statistical Significance ◽  
Ankle Fractures ◽  
Foot And Ankle ◽  
Ankle Osteoarthritis ◽  
Posterior Malleolus ◽  
Significant Difference ◽  
Functional Scores ◽  
The Mean

Background This study was performed to determine the factors that influence the clinical outcomes of surgically treated ankle fractures associated with the posterior malleolus (PM). Methods We evaluated 42 fractures of 42 patients. Posterior malleolus fracture size was calculated using computed tomography. Posterior malleolar fractures with a size less than 10% were left nonfixated. The decision for larger fragments was performed using fluoroscopy following the fixation of other components. If the joint was found to be congruent, the PM was left nonfixated. Otherwise, the PM was reduced and fixated. Clinical outcomes were evaluated based on Weber, Freiburg, and American Orthopaedic Foot and Ankle Society scores. Ankle osteoarthritis was determined according to the Canadian Orthopaedic Foot and Ankle Society classification. The effect of PM fixation, age, PM fragment size, waiting period before surgery, presence of ankle dislocation, and number of injured malleoli on clinical outcomes were assessed. Statistical significance was set at a value of P < .05. Results The mean patients age was 48.5 ± 14.9 years (range, 20–84 years) and the mean follow-up was 23.7 ± 8.6 months (range, 12–56 months). Fixation of the PM was performed solely in 12 patients. Postoperative displacement of the PM and articular step were less than 2 mm in all fractures. Statistically significant worse outcomes were demonstrated based on functional scores in the patients with a PM size greater than or equal to 25% (P = .042, P = .038, and P = .048, respectively) and in patients aged 60 years or older (P = .005, P = .007, and P = .018, respectively). However, there was no significant difference between functional scores and the other factors. Ankle osteoarthritis was observed at a higher rate in patients with PM size greater than or equal to 25% and in patients aged 60 years or older. Conclusions Clinical outcomes of the patients are mainly influenced by the patient's age and PM fragment size. However, if the tibiotalar joint is congruent, comparable results can be obtained in PM fixated or nonfixated patients.

scholarly journals Rising Burden of Alcohol-Associated Foot and Ankle Fractures Presenting to U.S. Emergency Departments: 2000-2017

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0034
Author(s):  
Kevin Pirruccio ◽  
Daniel C. Farber
Keyword(s):  
Alcohol Consumption ◽  
Emergency Departments ◽  
The United States ◽  
Ankle Fractures ◽  
Foot And Ankle ◽  
New Findings ◽  
Injury Mechanisms ◽  
Simple Regression Model ◽  
National Estimates ◽  
Simple Regression

Category: Ankle, Trauma, Epidemiology Introduction/Purpose: The most frequent cause of traumatic foot and ankle fractures is a fall to the ground. Alcohol consumption, especially in excess, has the potential to impart a significant fall risk on patients by reducing postural control resulting in imbalance. However, the relationship between the consumption of alcohol and the risk of traumatic foot and ankle fracture is poorly characterized. The purpose of this study was to report national estimates, injury mechanisms, and demographic characteristics of patients presenting to U.S. emergency departments (EDs) with traumatic foot and ankle fractures associated with alcohol consumption. Methods: This cross-sectional, retrospective epidemiological study analyzes case narratives in the National Electronic Injury Surveillance System (NEISS) database to examine national estimates of traumatic foot and ankle fractures associated with alcohol consumption presenting to U.S. emergency departments between 2000 and 2017, sampling in two-year intervals. Data from the Organisation for Economic Co-operation and Development (OECD) on the “Value for Total U.S. Adult Alcohol Consumption in Liters/Capita” was used in a simple regression model to demonstrate how increased alcohol consumption in the United States has predicted changes in the national number of alcohol-associated foot and ankle fractures over time. Results: Nationally, alcohol-associated foot and ankle fractures increased significantly between the 2000-2001 (N=2,878; C.I. 1,869-3,887) and 2016-2017 (N=8,778; C.I. 6,751-10,806) periods (p<0.001). Simple regression (R2 = 0.87; p<0.001) demonstrated that in the U.S., a one-tenth increase in the total liters of alcohol consumed per capita predicted an additional 606 alcohol-associated foot and ankle fractures presenting to U.S. EDs. About two-thirds of patients suffered ankle fractures (65.6%; C.I. 61.1%-70.1%). Fractures were commonly sustained by male patients (58.4%; C.I. 53.9%-62.9%) at home (46.5%; C.I. 40.9%- 52.2%); roughly one-third of patients required admission to the hospital (29.7%; C.I. 24.5%-34.9%). The most common injury mechanisms for alcohol-associated foot and ankle fractures were falls to the ground from standing height (33.0%; C.I. 28.8%- 37.2%), and falls down stairs or steps (31.0%; C.I. 26.1%-35.9%). Conclusion: Falls to the ground mechanistically link alcohol consumption to traumatic fractures of the foot and ankle. These new findings highlight how the negative societal impacts of alcohol – and potentially other substances – may be overlooked. As a result, this information should serve as an impetus to direct national attention towards awareness and preventative measures. Furthermore, our findings may help clinicians identify, educate, and counsel patients with certain demographic risk factors for alcohol-associated foot and ankle fractures.

Effect of Postoperative Ketorolac Administration on Bone Healing in Ankle Fracture Surgery

2018 ◽  
Vol 39 (10) ◽  
pp. 1135-1140 ◽  
Author(s):  
Elizabeth McDonald ◽  
Brian Winters ◽  
Kristen Nicholson ◽  
Rachel Shakked ◽  
Steven Raikin ◽  
...  
Keyword(s):  
Bone Healing ◽  
Case Series ◽  
Ankle Fractures ◽  
High Rate ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Radiographic Outcomes ◽  
Significant Difference ◽  
Clinical Healing ◽  
Mean Time

Background: In an effort to minimize narcotic analgesia and its potential side effects, anti-inflammatory agents offer great potential provided they do not interfere with bone healing. The safety of ketorolac administration after foot and ankle surgery has not been well defined in the current literature. The purpose of this study was to report clinical healing and radiographic outcomes for patients treated with a perioperative ketorolac regimen after open reduction and internal fixation (ORIF) of ankle fractures. Methods: A retrospective review was performed on all patients that received perioperative ketorolac at the time of lateral malleolar, bimalleolar, and trimalleolar ankle ORIF by a single surgeon between 2010 and 2016 with minimum 4 months follow-up. Patients received 20 tablets of 10 mg ketorolac Q6 hours. Radiographs were evaluated independently by 2 blinded fellowship-trained orthopedic foot and ankle surgeons to assess for radiographic healing. A total of 281 patients were included, with a median age of 51 years and 138 males (47%). Statistical analysis consisted of a linear mixed-effects regression. Results: In all, 265/281 (94%) were clinically healed within 12 weeks and 261/281 (92%) were radiographically healed within 12 weeks. Within the group of patients that did not heal within 12 weeks, mean time to clinical healing was 16.9 weeks (range = 14-25 weeks), and mean time to radiographic healing was 17.1 weeks (range = 14-25 weeks). In patients taking ketorolac, there were no cases of nonunion in our series (n = 281) and no significant difference found between fracture patterns and healing or complications ( P = .500). Conclusions: Perioperative ketorolac use was associated with a high rate of fracture union by 12 weeks. This is the first study to examine the effect of ketorolac on radiographic time to union of ankle fractures. Additional studies are necessary to determine whether ketorolac helps reduce opioid consumption and improve pain following ORIF of ankle fractures. Level of Evidence: Level IV, case series.

scholarly journals Initial Evaluation by a Nonoperative Provider Does Not Delay the Surgical Care of Operative Ankle Fractures in a Walk-in Orthopaedic Clinic

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0017
Author(s):  
Matthew N Fournier ◽  
Joseph T Cline ◽  
Adam Seal ◽  
Richard A Smith ◽  
Clayton C Bettin ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Ankle Fracture ◽  
Initial Evaluation ◽  
Orthopaedic Surgeon ◽  
Ankle Fractures ◽  
Definitive Treatment ◽  
Foot And Ankle ◽  
Orthopaedic Clinic ◽  
Orthopaedic Surgeons ◽  
Clinic Visits

Category: Ankle, Trauma Introduction/Purpose: Walk-in and “afterhours” clinics are a common setting in which patients may seek care for musculoskeletal complaints. These clinics may be staffed by orthopaedic surgeons, nonsurgical physicians, advanced practice nurses, or physician assistants. If orthopaedic surgeons are more efficient than nonoperative providers at facilitating the care of operative injuries in this setting is unknown. This study assesses whether evaluation by a nonoperative provider delays the care of patients with operative ankle fractures compared to those seen by an orthopaedic surgeon in an orthopaedic walk-in clinic. Methods: Following IRB approval, a cohort of patients who were seen in a walk-in setting and who subsequently underwent surgical treatment for an isolated ankle fracture were retrospectively identified. The cohort was divided based on whether the initial clinic visit had been conducted by an operative or nonoperative provider. A second cohort of patients who were evaluated and subsequently treated by a fellowship-trained foot and ankle surgeon in their private practice was used as a control group. Outcome measures included total number of clinic visits before surgery, total number of providers seen, days until evaluation by treating surgeon, and days until definitive surgical management. Results: 138 patients were seen in a walk-in setting and subsequently underwent fixation of an ankle fracture. 61 were seen by an orthopaedic surgeon, and 77 were seen by a nonoperative provider. No significant differences were found between the operative and nonoperative groups when comparing days to evaluation by treating surgeon (4.1 vs 4.5, p=.31), or days until definitive surgical treatment (8.4 vs 8.8, p=.58). 62 patients who were seen and treated solely in a single surgeon’s practice had significantly fewer clinic visits (1.11 vs 2.03 and 2.09, p<.05), as well as days between evaluation and surgery compared to the walk-in groups (5.44 vs 8.44 and 8.78, p<.05). Conclusion: Initial evaluation in a walk-in orthopaedic clinic setting is associated with a longer duration between initial evaluation and treatment compared to a conventional foot and ankle surgeon’s clinic, but this difference may not be clinically significant. Evaluation by a nonoperative provider is not associated with an increased duration to definitive treatment compared to an operative provider.

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