Vitamin D in Foot and Ankle Fracture Healing

Category: Ankle, Trauma Introduction/Purpose: Ankle fracture is one of the most common orthopedics injuries. Poor functional outcome, residual pain and discomfort is a major burden to the patients daily activities Complex regional pain syndrome (CRPS) is one of serious complication after orthopedics injuries .The incidence of CRPS is 0.3% after foot and ankle surgery. CRPS is well studied in wrist fracture. Vitamin C has been proposed to improve outcomes after a distal radius fracture by promotion of bone and soft-tissue healing and reducing the prevalence of complex regional pain syndrome (CRPS). We aim to detect the effect of vitamin C on the functional outcome, post op pain, incidence of CRPS, wound healing and fracture healing after an ankle fracture Methods: Prospective, Double blind, Randomized control study of 110 subjects (55 subjects in each group). Subjects in study group will receive 500 mg vitamin C for 50 days and standard of care, whereas control group will receive the stander of care alone. Subjects with age from 18-50 years old, with ankle fracture which treated surgically will be recruited, whereas open fracture, Peripheral vascular disease, Allergy to Vitamin C will be excluded. Subjects will be followed up in regular basis for one year. Primary end point will be diagnosis of CRPS and secondary end point will be failure of initial management Results: Although CRPS is more common in wrist injuries comparing to ankle injuries, subclinical of CRPS is more common after ankle fracture. Vitamin C showed promising results in decrease the incidence of CRPS in distal radius fracture. Literature lack of studies looking for CRPS and foot and ankle fracture without high evidence of effect of vitamin C on the functional outcome and post op pain after ankle fractures. Conclusion: We assume that vitamin C will improve functional outcome, decrease post op pain, decrease the incidence of CRPS and improve wound and fracture healing.

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

Foot & Ankle International ◽

10.1177/10711007211002811 ◽

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

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Experimental osteoporosis induced by ovariectomy and vitamin D deficiency does not markedly affect fracture healing in rats

Acta Orthopaedica ◽

10.1080/17453670710013988 ◽

2007 ◽

Vol 78 (3) ◽

pp. 393-403 ◽

Cited By ~ 38

Author(s):

Gunhild Melhus ◽

Lene B Solberg ◽

Sigbjoern Dimmen ◽

Jan E Madsen ◽

Lars Nordsletten ◽

...

Keyword(s):

Vitamin D ◽

Fracture Healing ◽

Vitamin D Deficiency ◽

Experimental Osteoporosis

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Surgical Considerations for Vitamin D Deficiency in Foot and Ankle Surgery

Orthopedic Clinics of North America ◽

10.1016/j.ocl.2018.10.008 ◽

2019 ◽

Vol 50 (2) ◽

pp. 259-267 ◽

Cited By ~ 3

Author(s):

Kenneth DeFontes ◽

Jeremy T. Smith

Keyword(s):

Vitamin D ◽

Vitamin D Deficiency ◽

Foot And Ankle ◽

Ankle Surgery

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

Journal of the American Podiatric Medical Association ◽

10.7547/18-087 ◽

2019 ◽

Vol 110 (3) ◽

Author(s):

Karan Malhotra ◽

Paul J. Baggott ◽

Julian Livingstone

Keyword(s):

Vitamin D ◽

Vitamin D Deficiency ◽

Cost Benefit ◽

Ultraviolet B ◽

Osteochondral Lesions ◽

Foot And Ankle ◽

High Quality Research ◽

Routine Testing ◽

Vitamin D Levels ◽

Healing Bone

Background Vitamin D is an essential vitamin that targets several 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. We reviewed the role of vitamin D and its deficiency in foot and ankle pathology. Methods 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 evidence regarding the foot and ankle consists of retrospective studies, which cannot determine whether vitamin D deficiency is, in fact, the cause of the pathologies being investigated. Results The available evidence suggests that insufficient vitamin D levels 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. Conclusions Based on the available evidence, we cannot recommend routine testing or supplementation of vitamin D in patients with foot and ankle pathology. However, supplementation is cheap, safe, and may be of benefit in patients at high risk for deficiency. When vitamin D is supplemented, the evidence suggests that 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 supplementation of vitamin D for foot and ankle pathology are also required.

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

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00174 ◽

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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