A Comparison of Complications and Reoperations Between Open Reduction and Internal Fixation Versus Primary Arthrodesis Following Lisfranc Injury

There is a lack of consensus in the literature regarding optimal treatment methods for Lisfranc injuries, and recent literature has emphasized the need to compare open reduction and internal fixation (ORIF) with primary arthrodesis (PA). The purpose of the current study is to compare reoperation and complication rates between ORIF and PA following Lisfranc injury in a private, outpatient, orthopaedic practice. A retrospective chart review was performed on patients undergoing operative intervention for Lisfranc injury between January 2009 and September 2015. A total of 196 patients met the inclusion criteria (130 ORIF, 66 PA), with a mean follow-up of 61.3 and 81.7 weeks, respectively. The ORIF group had a higher reoperation rate than the PA group, due to hardware removal. When hardware removals were excluded, the reoperation rate was similar. Postsurgical complications were compared between the 2 groups with no significant difference. In conclusion, ORIF and PA had similar complication rates. When hardware removals were excluded, the reoperation rates were similar, although hardware removals were more common in the ORIF group compared with the PA group. Levels of Evidence: Level III

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Reoperation Rate Differences Between Open Reduction Internal Fixation and Primary Arthrodesis of Lisfranc Injuries

Foot & Ankle International ◽

10.1177/1071100718774005 ◽

2018 ◽

Vol 39 (9) ◽

pp. 1089-1096 ◽

Cited By ~ 11

Author(s):

Matteo Buda ◽

Shaun Kink ◽

Ruben Stavenuiter ◽

Catharina Noortje Hagemeijer ◽

Bonnie Chien ◽

...

Keyword(s):

Risk Factors ◽

Internal Fixation ◽

Open Reduction ◽

Open Reduction Internal Fixation ◽

Hardware Removal ◽

Patient Risk ◽

Operation Room ◽

Lisfranc Injuries ◽

Reoperation Rates

Background: Controversy persists as to whether Lisfranc injuries are best treated with open reduction internal fixation (ORIF) versus primary arthrodesis (PA). Reoperation rates certainly influence this debate, but prior studies are often confounded by inclusion of hardware removal as a complication rather than as a planned, staged procedure inherent to ORIF. The primary aim of this study was to evaluate whether reoperation rates, excluding planned hardware removal, differ between ORIF and PA. A secondary aim was to evaluate patient risk factors associated with reoperation after operative treatment of Lisfranc injuries. Methods: Between July 1991 and July 2016, adult patients who sustained closed, isolated Lisfranc injuries with or without fractures and who underwent ORIF or PA with a minimum follow-up of 12 months were analyzed. Reoperation rates for reasons other than planned hardware removal were examined, as were patient risk factors predictive of reoperation. Two hundred seventeen patients met enrollment criteria (mean follow-up, 62.5 ± 43.1 months; range, 12-184), of which 163 (75.1%) underwent ORIF and 54 (24.9%) underwent PA. Results: Overall and including planned procedures, patients treated with ORIF had a significantly higher rate of return to the operation room (75.5%) as compared to those in the PA group (31.5%, P < .001). When excluding planned hardware removal, however, there was no difference in reoperation rates between the 2 groups (29.5% in the ORIF group and 29.6% in the PA group, P = 1). Risk factors correlating with unplanned return to the operation room included deep infection ( P = .009-.001), delayed wound healing ( P = .008), and high-energy trauma ( P = .01). Conclusion: When excluding planned removal of hardware, patients with Lisfranc injuries treated with ORIF did not demonstrate a higher rate of reoperation compared with those undergoing PA. Level of Evidence: Level III, retrospective comparative study

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Impact of fixation method on postoperative complication rates following surgical stabilization of diaphyseal tibial fractures in cats

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.3415/vcot-14-08-0120 ◽

2015 ◽

Vol 28 (02) ◽

pp. 109-115 ◽

Cited By ~ 5

Author(s):

M. Bruce ◽

K. L. Perry

Keyword(s):

Retrospective Study ◽

Internal Fixation ◽

Complication Rate ◽

Open Reduction ◽

Tibial Fractures ◽

Fixation Method ◽

Complication Rates ◽

Significant Difference ◽

Study Population

SummaryObjectives: To compare the complication rate between open reduction and internal fixation (ORIF) and external skeletal fixation (ESF) for feline diaphyseal tibial fractures.Methods: In a retrospective study spanning a 10 year period, 57 feline tibial fractures stabilized via ESF or ORIF were included for analysis and complication rates were compared between the two methods.Results: In the overall study population, 23 (40.4%) cases suffered complications (9 major, 20 minor, 6 with both major and minor). All of the major complications occurred in the ESF group. Complications were more common in cats with ESF (50.0%) while only one (7.7%) of the ORIF cases suffered complications (OR 12.0 [CI: 2.09; 228.10], p = 0.02). Use of postoperative antibiotic medications was identified as a confounder. After adjusting for confounding, stabilization using ESF remained associated with a higher risk of complications (OR = 13.71 [CI: 2.18; 274.25], p = 0.02). Cats with ESF had a longer duration of follow-up (15.6 weeks; 95% CI: 13.0; 18.3) compared to ORIF (9.5 weeks; 95% CI: 6.4; 12.7) (p = 0.003), and a higher number of revisits (mean 3.0; 95% CI: 2.4; 3.6) than the ORIF group (mean 1.6; 95% CI: 0.9; 2.3) (p = 0.002).Clinical significance: This study demonstrates a significant difference in complication rates between the methods of stabilization, with ESF resulting in a significantly higher complication rate compared to ORIF. Based on these results, it may be prudent to select ORIF for stabilization of feline tibial fractures wherever practical.

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Concomitant Osteotomy Reduces Risk of Reoperation Following Cartilage Restoration Procedures of the Knee: A Matched Cohort Analysis

Cartilage ◽

10.1177/19476035211011515 ◽

2021 ◽

pp. 194760352110115

Author(s):

Jacob G. Calcei ◽

Kunal Varshneya ◽

Kyle R. Sochacki ◽

Marc R. Safran ◽

Geoffrey D. Abrams ◽

...

Keyword(s):

Cohort Analysis ◽

Reoperation Rate ◽

Similar Rate ◽

Osteochondral Allograft ◽

Complication Rates ◽

Cartilage Restoration ◽

Chondrocyte Implantation ◽

The Cost ◽

Reoperation Rates

Objective The objective of this study is to compare the (1) reoperation rates, (2) 30-day complication rates, and (3) cost differences between patients undergoing isolated autologous chondrocyte implantation (ACI) or osteochondral allograft transplantation (OCA) procedures alone versus patients with concomitant osteotomy. Study Design Retrospective cohort study, level III. Design Patients who underwent knee ACI (Current Procedural Terminology [CPT] 27412) or OCA (CPT 27415) with minimum 2-year follow-up were queried from a national insurance database. Resulting cohorts of patients that underwent ACI and OCA were then divided into patients who underwent isolated cartilage restoration procedure and patients who underwent concomitant osteotomy (CPT 27457, 27450, 27418). Reoperation was defined by ipsilateral knee procedure after the index surgery. The 30-day postoperative complication rates were assessed using ICD-9-CM codes. The cost per patient was calculated. Results A total of 1,113 patients (402 ACI, 67 ACI + osteotomy, 552 OCA, 92 OCA + osteotomy) were included (mean follow-up of 39.0 months). Reoperation rate was significantly higher after isolated ACI or OCA compared to ACI or OCA plus concomitant osteotomy (ACI 68.7% vs. ACI + osteotomy 23.9%; OCA 34.8% vs. OCA + osteotomy 16.3%). Overall complication rates were similar between isolated ACI (3.0%) and ACI + osteotomy (4.5%) groups and OCA (2.5%) and OCA + osteotomy (3.3%) groups. Payments were significantly higher in the osteotomy groups at day of surgery and 9 months compared to isolated ACI or OCA, but costs were similar by 2 years postoperatively. Conclusions Concomitant osteotomy at the time of index ACI or OCA procedure significantly reduces the risk of reoperation with a similar rate of complications and similar overall costs compared with isolated ACI or OCA.

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Primary Arthrodesis Compared with Open Reduction and Internal Fixation for Lisfranc Injuries with the First Tarsometatarsal Joint Dislocation

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00132 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0013

Author(s):

Ming-Zhu Zhang ◽

Guang-rong Yu ◽

Mark Myerson

Keyword(s):

Internal Fixation ◽

Open Reduction ◽

Bodily Pain ◽

Open Reduction Internal Fixation ◽

Term Outcome ◽

Lisfranc Injury ◽

Joint Dislocation ◽

Sf 36 ◽

First Ray ◽

Lisfranc Injuries

Category: Trauma Introduction/Purpose: The first tarsometatarsal (TMT) joint is very crucial for midfoot stability. To address its importance, retrospective analyses of treatment for the first TMT joint dislocation with Lisfranc injury was performed in a multi-center manner. Comparison of open reduction internal fixation (ORIF) and primary arthrodesis was conducted for the injury. Methods: This multi-center study was involved ten clinical institutions in different area of China. .From January 2003 to June 2015, 126 Lisfranc injuries with first TMT joint dislocation underwent surgical intervention. Of this group, forty one (32.5%) feet were first TMT joint dislocation only. Eighty five feet were first TMT joint dislocation and fractures. They were 76 males (60.3%) and 50 females (39.7%) with a mean age of 45.5 (range, 20-87) years. The duration from injury to surgery is 11.7 (range, 4-26) days. Two groups were divided by surgery methods as open reduction internal fixation (ORIF) group and primary arthrodesis group. Ninety two patients were performed by ORIF, while primary arthrodesis group including 34 cases. Outcome measures included clinical examination, radiographs, AOFAS ankle-hindfoot scores, visual analogue scale (VAS) and SF-36 scores. Complications and revision rate were analyzed as well. Results: 126 patients were followed up for 29.5 months. At 1.5 years postoperatively, the AOFAS score was 79 and 85 in ORIF group and arthrodesis group.The VAS score was 3.1 separately in two groups.The mean Physical Functioning sores of SF-36 was 80.3 points and 83.5• points. The Bodily Pain score of SF-36 was 76.1 points and 84.6• points.Redislocation of first tarsometarsal joint were observed in 16 cases among ORIF group.36 patients in ORIF group had pain in midfoot, eight of them had persistent pain with the development of deformity or osteoarthrosis.No redislocation and no hardware failure was identified in arthrodesis group Conclusion: Primary stable arthrodesis of the first ray gives a better short and medium term outcome than open reduction and internal fixation for Lisfranc injury with the first ray dislocation. Possible complication and revision could be avoided by primary arthrodesis for dislocated first ray injuries.

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Primary Arthrodesis Compared with Open Reduction and Internal Fixation for Lisfranc Injuries with the First Tarsometatarsal Joint Dislocation: A Randomized Controlled Trial

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00078 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0007

Author(s):

Mingzhu Zhang ◽

Guangrong Yu

Keyword(s):

Internal Fixation ◽

Open Reduction ◽

Controlled Trial ◽

Bodily Pain ◽

Lisfranc Injury ◽

Joint Dislocation ◽

Tarsometatarsal Joint ◽

Sf 36 ◽

First Ray ◽

Lisfranc Injuries

Category: Midfoot/Forefoot, Trauma Introduction/Purpose: Prospective analyses of treatment for the first tarsometatarsal joint dislocation with Lisfranc injury. Comparison of open reduction internal fixation (ORIF) and primary arthrodesis was conducted for the injury. Methods: 78 Lisfranc injuries with first tarsometatarsal joint dislocation underwent surgical intervention. They were 46 males and 32 females with mean age of 41.2 years. Two groups were randomized by ORIF group and primary arthrodesis group. 43 patients were performed by ORIF, while primary arthrodesis group including 35 cases. Outcome measures included radiographs, AOFAS scores, VAS and SF-36 scores. Complications and revision rate were analyzed also. Results: 73 patients were followed up for 21 months. At 1.5 years postoperatively, the AOFAS score was 75 and 83 in ORIF group and arthrodesis group. The VAS score was 3.0 and 2.1 separately in two groups. The mean Physical Functioning sores of SF- 36 was 81.2 points and 84.1 points. The Bodily Pain score of SF-36 was 79.3 points and 85.2 points. Redislocation of first tarsometarsal joint were observed in 11 cases among ORIF group.31 patients in ORIF group had pain in midfoot, six of them had persistent pain with the development of deformity or osteoarthrosis. No redislocation and no hardware failure was identified in arthrodesis group. Conclusion: Primary stable arthrodesis of the first ray gives a better short and medium term outcome than open reduction and internal fixation for Lisfranc injury with the first ray dislocation. Possible complication and revision could be avoided by primary arthrodesis for dislocated first ray injuries.

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DISI DEFORMITY AND POST-OPERATIVE SYMPTOMS OF SCAPHOID NON-UNION

Hand Surgery ◽

10.1142/s0218810499000393 ◽

1999 ◽

Vol 04 (02) ◽

pp. 117-124 ◽

Cited By ~ 3

Author(s):

T. Wada ◽

M. Aoki ◽

M. Usui ◽

S. Ishii

Keyword(s):

Internal Fixation ◽

Grip Strength ◽

Bone Grafting ◽

Open Reduction ◽

Average Duration ◽

Bone Screw ◽

Non Union ◽

Significant Difference ◽

Corticocancellous Bone Grafting

The correlation between the residual dorsal intercalated segmental instability (DISI) deformity and symptoms of the wrist was investigated in 20 patients with healed scaphoid non-union who had open reduction and bone grafting. In seven patients, inlay corticocancellous bone grafting (modified Russe procedure) was performed. In four of the seven patients, an additional Herbert bone screw was used for internal fixation. The remaining 13 patients were treated with open reduction, anterior bone grafting, and internal fixation with Herbert bone screw. Average duration of follow-up period after operation was 20 months (range, 6 to 57 months). The average extension-flexion arc of the injured wrists was 129°, which was 31° less than that of the uninjured wrists. The average grip strength of the injured wrists was 89% of that of the uninjured wrist. Before the operation, all 20 patients were symptomatic and complained of wrist pains. Post-operatively, three patients experienced mild pains and only one complained of moderate wrist pains. Post-operative radiolunate angle ranged from 0° to 34° (average 10°). DISI deformity remained uncorrected in eight patients. Post-operative symptoms were compared amongst the eight patients who had DISI deformity and 12 patients who had no deformity. There was no significant difference in range of motion, grip strength, and incidence of pain between these two groups of patients. The presence of DISI deformity after bone grafting for a symptomatic scaphoid non-union was not predictive of post-operative symptoms of the wrist.

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Comparison of Autologous Chondrocyte Implantation and Osteochondral Allograft Transplantation of the Knee in a Large Insurance Database: Reoperation Rate, Complications, and Cost Analysis

Cartilage ◽

10.1177/1947603520967065 ◽

2020 ◽

pp. 194760352096706

Author(s):

Kyle R. Sochacki ◽

Kunal Varshneya ◽

Jacob G. Calcei ◽

Marc R. Safran ◽

Geoffrey D. Abrams ◽

...

Keyword(s):

Autologous Chondrocyte Implantation ◽

Reoperation Rate ◽

Osteochondral Allograft ◽

Complication Rates ◽

Allograft Transplantation ◽

Chondrocyte Implantation ◽

Reoperation Rates ◽

Insurance Database ◽

Autologous Chondrocyte

Objective To compare (1) the reoperation rates, (2) risk factors for reoperation, (3) 30-day complication rates, and (4) cost differences between autologous chondrocyte implantation (ACI) and osteochondral allograft transplantation (OCA) of the knee in a large insurance database. Design Subjects who underwent knee ACI (Current Procedural Terminology [CPT] code 27412) or OCA (CPT code 27415) with minimum 2-year follow-up were queried from a national insurance database. Reoperation was defined by ipsilateral knee procedure after index surgery. Multivariate logistic regression models were built to determine the effect of independent variables (age, sex, tobacco use, obesity, diabetes, and concomitant osteotomy) on reoperation rates. The 30-day complication rates were assessed using ICD-9-CM codes. The cost of the procedures per patient was calculated. Statistical comparisons were made. All P values were reported with significance set at P < 0.05. Results A total of 909 subjects (315 ACI and 594 OCA) were included (mean follow-up 39.2 months). There was a significantly higher reoperation rate after index ACI compared with OCA (67.6% vs. 40.4%, P < 0.0001). Concomitant osteotomy at the time of index procedure significantly reduced the risk for reoperation in both groups (odds ratio [OR] 0.2, P < 0.0001 and OR 0.2, P = 0.009). The complication rates were similar between ACI (1.6%) and OCA (1.2%) groups ( P = 0.24). Day of surgery payments were significantly higher after ACI compared with OCA ( P = 0.013). Conclusions Autologous chondrocyte implantation had significantly higher reoperation rates and cost with similar complication rates compared with OCA. Concomitant osteotomy significantly reduced the risk for reoperation in both groups.

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Retrospective study about the postoperative stability of zygomaticomaxillary complex fracture

Maxillofacial Plastic and Reconstructive Surgery ◽

10.1186/s40902-021-00311-9 ◽

2021 ◽

Vol 43 (1) ◽

Author(s):

Seoghwan Yang ◽

Jin-yong Cho ◽

Woo-chul Shim ◽

Sungbeom Kim

Keyword(s):

Computed Tomography ◽

Retrospective Study ◽

Internal Fixation ◽

Open Reduction ◽

Complex Fracture ◽

Significant Difference ◽

Zygomaticomaxillary Complex Fracture ◽

The Difference ◽

Zygomaticomaxillary Complex

Abstract Background The aim of this study is to evaluate the postoperative stability of zygomaticomaxillary complex (ZMC) fractures according to the number of fixation sites and to investigate the direction of postoperative displacement of the unfixed part of the fractured segment. Methods This study was retrospectively performed on 38 patients who were treated by open reduction and internal fixation of ZMC fractures and were taken postoperative computed tomography (CT) between February 2012 and July 2019. The patients were classified into 3 groups: 1-point fixation, 2-point fixation, 3-point fixation according to the number of fixations. The postoperative displacement of the fractured segment was evaluated by the superimposition between postoperative CT and follow-up CT, and the postoperative stability according to the fixation sites was investigated through the amount of postoperative displacement. In addition, it was investigated in which direction the location of the fractured segment was changed in the unfixed fractured segment according to the fixation sites. Results The amount of postoperative displacement of the fractured segment was 0.75 ± 1.18 mm on average. In the postoperative displacement of the distal area according to the number of fixation of the fracture, there was no statistically significant difference in the amount of displacement of the fracture (p = 0.574). As for the direction of the change in the location of the fractured segment, 12 patients among 38 patients with the change in the location of the fractured segment were investigated, and the displacement in the medial direction (n = 11, 91.67%) was the most common in all three fixation methods. Conclusion In patients with a ZMC fracture who were treated by open reduction and internal fixation, the number of fixations did not make the difference in the postoperative displacement of the fracture. In addition, the fractured segment mainly changes in the medial direction after surgery, and this fact can be used as a reference for the reduction direction during surgery for the stable prognosis.

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Comparison of open reduction and internal fixation versus closed reduction and percutaneous fixation for medial malleolus fractures

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000286 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0002

Author(s):

Andrew Matson ◽

Stephen Barchick ◽

Samuel Adams

Keyword(s):

Internal Fixation ◽

External Fixation ◽

Closed Reduction ◽

Open Reduction ◽

Wound Complications ◽

Complication Rates ◽

Percutaneous Fixation ◽

Open Injury ◽

Increased Risk ◽

Significant Difference

Category: Ankle, Trauma Introduction/Purpose: Open approaches are often used for the operative treatment of medial malleolar (MM) fractures. Compared to percutaneous approaches, open approaches may entail an increased risk of operative morbidity, postoperative pain, wound complications, and reoperation for hardware removal. However, inherent to minimally invasive or percutaneous techniques is incomplete fracture visualizationwhich may hinder acceptable reduction. In this study, we aimed to compare patients treated with closed reduction and percutaneous fixation (CRPF) to those patients treated with traditional open reduction and internal fixation (ORIF). We hypothesized that the two groups would be similar with regard to patient factors, injury variables, and outcomes. Methods: The study group consisted of 184 consecutive patients who met inclusion criteria and were treated with operative fixation of a MM fracture from 2011-2015 at a single institution. Forty underwent CRPF and 144 underwent ORIF. Patient demographics, injury characteristics, treatment methods, and outcome variables were recorded through review of patient charts, radiographs, and operative reports. Results: Patient variables were similar between groups except for years of age, which was greater on average in the CRPF group (55 vs. 48, p = 0.03). The CRPF treatment group had a higher rate of initial open injury (22% vs. 7%, p<0.01), a lower rate of MM fracture comminution (12% vs. 29%, p = 0.03), and a higher rate of provisional external fixation (35% vs. 14%, p<0.01). There was no statistically significant difference observed between the CRPF and ORIF groups with regard to outcomes including: nonunion (2% vs. 3%), malunion (10% vs. 5%), time to union (10 weeks, each), removal of hardware (8% vs. 14%), or wound complications (0% vs. 4%). Conclusion: Both CRPF and ORIF resulted in acceptable radiographic outcomes and low complication rates for the treatment of MM fractures. Compared to the ORIF group, patients in the CRPF group on average were older and more often had comminution, open fractures, and provisional external fixation.

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Timing of Open Reduction and Internal Fixation of Ankle Fractures

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000388 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0003

Author(s):

Direk Tantigate ◽

J. Turner Vosseller ◽

Justin Greisberg ◽

Benjamin Ascherman ◽

Christina Freibott ◽

...

Keyword(s):

Internal Fixation ◽

Functional Outcome ◽

Functional Outcomes ◽

Ankle Fracture ◽

Open Reduction ◽

Demographic Variables ◽

Ankle Fractures ◽

Significant Difference ◽

The Mean

Category: Ankle, Trauma Introduction/Purpose: Unstable ankle fractures are typically treated with open reduction and internal fixation (ORIF) for stabilization in an effort to ultimately prevent post-traumatic arthritis. It is not uncommon for operative treatment to be performed as an outpatient in the ambulatory surgery setting several days to a couple weeks after the injury to facilitate things from a scheduling perspective. It is unclear what effect this delay has on functional outcome. The purpose of this study is to assess the impact of delayed operative treatment by comparing the functional outcomes for groups of patients based on the amount of time between the injury and surgery. Methods: A retrospective chart review of 122 ankle fracture patients who were surgically treated by ORIF over a three year period was performed. All ankle fracture patients older than 18 years with a minimum of 24 months of follow-up were included. A total of 61 patients were included for this study. Three patients were excluded; 2 patients had an open injury and 1 patient presented with a delayed union. Demographic data, comorbidities, injury characteristics, duration from injury to surgery, operative time, length of postoperative stay, complications and functional outcomes were recorded. Functional outcome was determined by Foot and Ankle Outcome Score (FAOS) at the latest follow-up visit. Comparison of demographic variables and the subcategory of FAOS including symptoms, pain, activities of daily living (ADL), sport activity and quality of life (QOL) was performed between patient underwent ORIF less than 14 days after injury and 14 days or greater. Results: A total of 58 patients were included in this study. Thirty-six patients (62.1%) were female. The mean age of patients was 48.14 ± 16.84 years (19-84 years). The mean follow-up time was 41.48 ± 12.25 months (24-76 months). The duration between injury and operative fixation in the two groups was 7 ± 3 days (<14 days) and 18 ± 3 days (>14 days), respectively. There was no statistically significant difference in demographic variables, comorbidities, injury characteristics, or length of operation. Each subcategory of FAOS demonstrated no statistically significant difference between these two groups. (Table 1) Additionally, further analysis for the delayed fixation more than 7 days and 10 days also revealed no significant difference of FAOS. Conclusion: Open reduction and internal fixation of ankle fracture more than 14 days does not significantly diminish functional outcome according to FAOS. Delay of ORIF for ankle fractures does not play a significant role in the long-term functional outcome.

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