scholarly journals Reoperation in Zygomatico-orbital Trauma: A Review of Patients With Suboptimal Outcomes Following Initial Repair

2020 ◽  
Vol 13 (3) ◽  
pp. 205-210
Author(s):  
Richard Taylor ◽  
Deepshikha Kumar ◽  
Jai Ghelani ◽  
Iain Varley
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Preoperative Imaging ◽  
Surgical Approaches ◽  
Orbital Fractures ◽  
Orbital Trauma ◽  
Factors Affecting ◽  
Intraoral Approach ◽  
Increased Risk ◽  
Operative Notes

Introduction: Treatment to restore anatomy, function, and aesthetics after trauma should involve as little surgical insult as possible. As such, repeated procedures may suggest failed initial management. To date, no predictive factors for failure of primary surgery have been identified. Objectives: The aim of this review was to identify factors affecting the requirement for reoperation following treatment of zygomatico-orbital injuries. Study Design and Methods: A retrospective review of patients undergoing surgery for zygomatico-orbital fractures between 2011 and 2019 in a single UK major trauma center was undertaken. All operative notes and imaging were reviewed independently by 2 authors to classify the fracture patterns for both zygomatic and orbital components of the injury. For all cases, the mode of preoperative imaging the grade of operating surgeon, materials used for fixation, and the surgical approaches were recorded. Results: Coding data identified 432 patients who underwent surgery for zygomatico-orbital fractures. In total, 116 cases were treated with closed reduction and 316 with open reduction and internal fixation; 20 cases required reoperation. There were no significant differences identified between cases requiring reoperation and those who did not. Conclusions: A need for repeated surgery is rare. However, this review identified an increased risk of infection of fixation when an intraoral approach was used and highlights the potential benefits that can be achieved by open reduction and internal fixation when more conservative approaches fail to achieve the desired outcome.

FACTORS AFFECTING THE FUNCTIONAL RESULTS OF OPEN REDUCTION AND INTERNAL FIXATION FOR FRACTURE-DISLOCATIONS OF THE PROXIMAL INTERPHALANGEAL JOINT

Hand Surgery ◽  
2015 ◽  
Vol 20 (01) ◽  
pp. 107-114 ◽  
Author(s):  
Kentaro Watanabe ◽  
Yoshitake Kino ◽  
Hiroki Yajima
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Functional Results ◽  
Fracture Dislocation ◽  
Factors Affecting ◽  
Flexion Extension ◽  
Motion Exercise ◽  
Fracture Dislocations ◽  
Pip Joint ◽  
The Mean

To clarify the factors affecting functional results of fracture-dislocations of the proximal interphalangeal (PIP) joint treated by open reduction and internal fixation (ORIF), 60 patients, including 38 patients with a dorsal fracture-dislocation and 22 with a pilon fracture, were analysed. The mean ratio of articular surface involvement was 48.5% and a depressed central fragment existed in 75.3% of the cases. ORIF was performed in 47 patients through a lateral approach using Kirschner wires and in 13 through a palmar approach using a plate or screws. The mean flexion, extension and range of motion (ROM) of the PIP joint was 89.5°, 11.5° and 78.0°, respectively. Stepwise regression analysis revealed that a delayed start of active motion exercise after surgery, elderly age and ulnar ray digit were factors affecting functional outcomes. Although ORIF allows accurate restoration of the articular surfaces, an early start of motion exercise is essential for good results.

scholarly journals Increased Rates of Readmission, Reoperation, and Mortality Following Open Reduction and Internal Fixation of Ankle Fractures Are Associated with Diabetes Mellitus

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0032
Author(s):  
Jennifer Liu ◽  
Junho Ahn ◽  
Dane Wukich ◽  
Katherine Raspovic
Keyword(s):  
Diabetes Mellitus ◽  
Internal Fixation ◽  
Ankle Fracture ◽  
Open Reduction ◽  
Large Scale ◽  
Ankle Fractures ◽  
Unplanned Readmission ◽  
Diabetic Patients ◽  
Acs Nsqip ◽  
Increased Risk

Category: Ankle Introduction/Purpose: Ankle fractures are amongst the most common type of fracture injury in adults with an annual incidence of 187 fractures per 100,000 people in the United States. Previous groups have shown that diabetes mellitus (DM) is associated with a myriad of complications – including infection, malunion, and impaired wound healing – following open reduction internal fixation (ORIF) surgery for ankle fractures. However, to our knowledge there has not been a large-scale nationwide study on the rate of readmission, reoperation, and mortality associated with DM. The purpose of this study was to calculate the increased risk and odds ratios for 30-day postoperative readmission, reoperation, and mortality after ankle fracture ORIF. Methods: Patients who underwent ORIF for ankle fractures from 2006 to 2015 were identified in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database using Current Procedural Terminology codes. Median values along with 25th to 75th interquartile ranges (IQRs) were used to describe continuous variables and frequency (%) was used to describe categorical variables. Patient demographic factors along with 30-day postoperative outcomes were compared between those who had DM and those who did not have DM using the Mann-Whitney test or?2 test. 30-day postoperative unplanned readmission, unplanned reoperation, and mortality rates were compared in 2,044 patients with DM and 15,420 patients without DM. Crude odds ratios (OR) and adjusted ORs controlling for age differences were calculated for each parameter with a 95% confidence interval (CI). All statistical analyses were performed with a significance level of 0.05. Results: Patient factors and pre-operative laboratory statistics are summarized in Figure 1D, and the distribution of ankle fractures types are shown in Figure1A&B. Comparing patients with DM vs without DM, the rate of readmission was 4.35% vs 1.50%, rate of reoperation was 2.30% vs 0.75%, and rate of mortality was 0.73% vs 0.21%. As shown in Figure 1C, we found that patients with DM had a 2.66 times increased risk of readmission (CI: 1.99-3.52, p = 0.0001), 2.76 increased risk of reoperation (CI: 1.91-3.92, p = 0.0001), and a 2.34 increased risk of mortality (CI: 1.19-4.44, p = 0.0377). Interestingly, we also found a 22.06 increased risk of amputation (CI: 3.29-344.8, p = 0.0063) though the rate of amputation in both groups was very small. Conclusion: In this large-scale retrospective study we showed that the presence of diabetes mellitus significantly increases the risk of unplanned readmission, unplanned reoperation, and mortality within 30 days after ankle fracture ORIF surgery. Thus, patients with diabetes that require ORIF ankle surgery should be informed of their increased risk of complications and extra precautions should be taken to minimize risk. Further research in optimization of perioperative care for diabetic patients is crucial to reducing rates of complication. Large clinical databases such as ACS-NSQIP should endeavor to collect more parameters on diabetic patients to facilitate these studies.

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

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.

Association of Bleeding Disorders and Risk of Complications Following Open Reduction and Internal Fixation of the Ankle

2021 ◽  
pp. 107110072110581
Author(s):  
Alisa Malyavko ◽  
Theodore Quan ◽  
William T. Stoll ◽  
Joseph E. Manzi ◽  
Alex Gu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Postoperative Complications ◽  
Internal Fixation ◽  
Operative Treatment ◽  
Ankle Fracture ◽  
Open Reduction ◽  
Bleeding Disorder ◽  
Ankle Fractures ◽  
Bleeding Disorders ◽  
Increased Risk

Background: Open reduction and internal fixation (ORIF) of the ankle is a common procedure performed to correct ankle fractures in many different patient populations. Diabetes, peripheral vascular disease, and osteoporosis have been identified as risk factors for postoperative complications following surgery for ankle fractures. To date, there have not been any studies evaluating postoperative outcomes in patients with bleeding disorders undergoing operative treatment for ankle fractures. The aim of this study was to determine the postoperative complication rate following ORIF of the ankle in patients with a bleeding disorder vs those without a bleeding disorder. Methods: From 2006 to 2018, patients undergoing operative treatment for ankle fracture were identified in the National Surgical Quality Improvement Program database. Two patient cohorts were defined: patients with a bleeding disorder and patients without a bleeding disorder. Patients who underwent either inpatient or outpatient ORIF of the ankle were included in this study. In this analysis, demographics, medical comorbidities, and postoperative complications variables were assessed between the 2 cohorts. Bivariate and multivariate analyses were performed. Results: Of 10 306 patients undergoing operative treatment for ankle fracture, 9909 patients (96.1%) had no bleeding disorder whereas 397 patients (3.9%) had a bleeding disorder. Following adjustment on multivariate analysis, compared to patients who did not have a bleeding disorder, those with a bleeding disorder had an increased risk of any postoperative complications (odds ratio [OR] 1.48, 95% confidence interval [CI] 1.05-2.08, P = .024), requirement for postoperative blood transfusion (OR 2.86, 95% CI 1.53-5.36, P = .001), and extended length of hospital stay greater than 5 days (OR 1.46, 95% CI 1.10-1.93, P = .010). Conclusion: Patients with bleeding disorders are associated with increased risk of postoperative complications following ORIF for ankle fractures. Determining patient risk factors and creating optimal preoperative and perioperative management plans in patients with bleeding disorders undergoing ORIF can be beneficial in reducing postoperative complications, improving patient outcomes, and reducing overall morbidity. Level of Evidence: Level III, retrospective cohort study.

Sign in / Sign up

Export Citation Format

Share Document