scholarly journals Lower Complication Rate Following Ankle Fracture Fixation by Orthopaedic Surgeons Versus Podiatrists

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000
Author(s):  
Jeremy Chan ◽  
Jeremy Truntzer ◽  
Michael Gardner ◽  
Julius Bishop
Keyword(s):  
Postoperative Complications ◽  
Operative Treatment ◽  
Fracture Fixation ◽  
Ankle Fracture ◽  
Ankle Fractures ◽  
Scope Of Practice ◽  
Complication Rates ◽  
Orthopaedic Surgeons ◽  
Irrigation And Debridement ◽  
Lower Complication

Category: Ankle, Trauma Introduction/Purpose: Although the scope of practice for orthopaedic surgeons and podiatrists have considerable overlap in many foot and ankle pathologies, there are significant differences between the training for each surgical specialty that may affect patient outcomes. The purpose of this study was to evaluate complication rates following fixation of ankle fractures based on provider type. Our hypothesis was that patients with ankle fractures treated by orthopaedic surgeons would have lower complication rates compared to patients treated by podiatrists. Methods: This was a retrospective cohort study of data extracted from the Humana Claims database for 15,067 patients who underwent ankle fracture fixation between 2007 and 2015. Procedure type was identified by Current Procedural Terminology (CPT) codes. Patient data was subcategorized by surgeon type (orthopaedic surgeon versus podiatrist) and whether the patient underwent operative treatment for a single malleolus fracture (CPT 27766, 27792) versus a bimalleolar or a trimalleolar fracture (CPT 27814, 27822, 27823). The primary outcome was postoperative complications within 3 months including malunion, infection, or deep vein thrombosis (DVT). Secondary outcomes included reoperation rates for implant removal or irrigation and debridement. Complications were identified by International Classification of Disease-9 (ICD-9) codes and reoperations were identified by CPT codes. Chi-squared tests were used to determine differences in complication rates between surgeon types. The Charlson comorbidity index (CCI) was used to compare populations based on medical risk factors for complications. Results: 14,222 patients with ankle fractures were treated by orthopaedic surgeons and 845 patients were treated by podiatrists. Operative treatment by orthopaedists was associated with lower DVT (p<0.02) and malunion (p<0.02) rates among all types of ankle fractures. There were no differences in complications for patients with single malleolar fractures, although higher rates of implant removal (p<0.01) were noted in patients treated by orthopaedic surgeons. For bimalleolar or trimalleolar fractures, treatment by an orthopaedic surgeon was associated with lower DVT (p<0.03) and malunion (p<0.04) rates. No differences were observed in rates of infection or need for irrigation and debridement based on surgeon type (Table 1). Patients treated by orthopaedic surgeons versus podiatrists were also noted to have a similar median CCI at 2.0 and 2.5, respectively. Conclusion: Operative treatment of ankle fractures by orthopaedic surgeons is associated with lower rates of certain postoperative complications compared with podiatrists. Malunion, in particular, is a surgeon related variable that has a significant impact on functional outcome in unstable ankle fracture patients. The specific reasons for the difference in malunion rates is likely multifactorial, and unable to be answered using this dataset, but warrants further investigation. Our findings have important implications for patients who must choose a surgeon to manage their operative ankle fracture, as well as policy makers who determine scope of practice in orthopaedic surgeons and podiatrists alike.

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.

scholarly journals Comparison of Spatiotemporal Gait Parameters Following Operative Treatment of Trimalleolar Ankle Fractures vs Healthy Controls

2020 ◽  
Vol 5 (3) ◽  
pp. 247301142093105
Author(s):  
Andrew F. Tyler ◽  
Thomas Rose ◽  
Scott Day ◽  
Jessica Kenia ◽  
Annamarie D. Horan ◽  
...  
Keyword(s):  
Operative Treatment ◽  
Postoperative Period ◽  
Fracture Fixation ◽  
Ankle Fracture ◽  
Early Postoperative Period ◽  
Ankle Fractures ◽  
Gait Patterns ◽  
Posterior Malleolus ◽  
Gait Parameters ◽  
Healthy Control

Background: Controversy continues regarding appropriate indications for posterior malleolus fracture fixation in unstable rotational trimalleolar ankle injuries, with limited data comparing gait in operatively treated trimalleolar ankle fractures vs control populations. The purpose of this study was to evaluate the effect of trimalleolar ankle fracture fixation on gait parameters in the early postoperative period as compared to a healthy control population. Methods: Adult patients having undergone operative treatment of isolated trimalleolar ankle fractures were eligible for inclusion. A total of 10 patients met the inclusion criteria and participated in the analysis. Patients were evaluated using standard parameters of human gait 6 months after their index procedures, with gait values compared to a population of 17 non–age-matched healthy control subjects in addition to literature values of healthy populations of younger and older subjects. Results: Significant differences were noted between the spatiotemporal gait parameters of healthy control subjects and patients who had undergone operative treatment of trimalleolar ankle fractures. However, within the fracture group itself, no differences were found between patients with or without posterior malleolar fixation for any of the tested gait parameters. When patients were compared to literature values of younger and older healthy control populations, they were found to have gait patterns more similar to older rather than younger individuals. Conclusion: Operative fixation of trimalleolar ankle fracture does not restore normal gait function in the early postoperative period. Fixation of the posterior malleolus in particular also does not appear to improve gait characteristics. Patients who undergo surgery for these injuries demonstrate gait patterns similar to those of healthy older adults. Level of Evidence: Level II, Therapeutic (prospective cohort study).

scholarly journals Hypoalbuminemia is an Independent Predictor of 30-Day Postoperative Complications Following Surgical Fixation of Ankle Fractures

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0030
Author(s):  
Nathan Kukowski ◽  
Jacob M. Wilson ◽  
Jason T. Bariteau ◽  
Christopher A. Staley
Keyword(s):  
Postoperative Complications ◽  
Serum Albumin ◽  
Ankle Fracture ◽  
Continuous Variable ◽  
Albumin Level ◽  
Ankle Fractures ◽  
Postoperative Outcomes ◽  
Orthopedic Procedures ◽  
Complication Rates ◽  
Preoperative Serum

Category: Basic Sciences/Biologics; Trauma; Other Introduction/Purpose: Malnutrition is known to be negatively associated with outcomes after multiple orthopedic procedures. We hypothesized that admission albumin levels, as a maker for malnutrition, would correlate with postoperative outcomes. The purpose of this study is to investigate this relationship following surgery for ankle fracture. Methods: This is a retrospective cohort study of the ACS-NSQIP database. Patients undergoing operative fixation of an ankle fracture were identified. 6,138 patients with albumin available for analysis were identified. Baseline patient information, preoperative serum albumin levels, 30-day postoperative complications, readmission, reoperation, and length of stay data were then collected. Poisson regression with robust error variance was performed to assess the effect of preoperative serum albumin level on postoperative outcomes. Results: 6,138 patients with albumin available for analysis were identified in the database. The mean albumin level was 3.86 g/dl and 20.3% of patients with available albumin levels were hypoalbuminemic. Multivariate analysis revealed that albumin level <3.5 g/dl is an independent risk factor for complication (RR 1.42, 95% CI 1.13-1.78, p=0.002) and readmission (RR 1.54, 95% CI 1.13- 2.08, p =0.006). Additionally, when analyzed as a continuous variable, albumin level was negatively correlated with risk of mortality (RR 0.37, 95% CI 0.19-0.72, p=0.003). Patients with hypoalbuminemia also had significantly longer length of stays (4.5 v. 2.1 days, p<0.001). Conclusion: While complication rates after fixation of ankle fractures remain low, hypoalbuminemia is a predictor of postoperative course. Malnutrition, therefore, may help inform the decision between surgical and conservative management of patients with ankle fractures potentially amenable to non-operative management. Additionally, hypoalbuminemia should trigger heightened awareness and prophylactic therapy where appropriate.

Role of Hypoalbuminemia as an Independent Predictor of 30-Day Postoperative Complications Following Surgical Fixation of Ankle Fractures

2019 ◽  
Vol 41 (3) ◽  
pp. 303-312 ◽  
Author(s):  
Jacob M. Wilson ◽  
Nathan R. Kukowski ◽  
Christopher A. Staley ◽  
Jason T. Bariteau
Keyword(s):  
Postoperative Complications ◽  
Serum Albumin ◽  
Ankle Fracture ◽  
Albumin Level ◽  
Ankle Fractures ◽  
Postoperative Outcomes ◽  
Orthopedic Procedures ◽  
Complication Rates ◽  
Improvement Program ◽  
Preoperative Serum

Background: Malnutrition is known to be negatively associated with outcomes after multiple orthopedic procedures. We hypothesized that admission albumin levels, as a marker for malnutrition, would correlate with postoperative outcomes. The purpose of this study was to investigate this relationship following surgery for ankle fracture. Methods: This is a retrospective cohort study of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Patients undergoing operative fixation of an ankle fracture were identified. A total of 6138 patients with albumin available for analysis were identified. Baseline patient information, preoperative serum albumin levels, 30-day postoperative complications, readmission, reoperation, and length of stay data were then collected. Poisson regression with robust error variance was performed to assess the effect of preoperative serum albumin level on postoperative outcomes. Results: The mean albumin level was 3.86 g/dL and 20.3% (1246/6138) of patients with available albumin levels were hypoalbuminemic. Multivariate analysis revealed that an albumin level <3.5 g/dL was an independent risk factor for complications (relative risk [RR], 1.42; 95% confidence interval [CI], 1.13-1.78; P = .002) and readmission (RR, 1.54; 95% CI, 1.13-2.08; P = .006). Additionally, when analyzed as a continuous variable, albumin level was negatively correlated with risk of mortality (RR, 0.37; 95% CI, 0.19-0.72; P = .003). Patients with hypoalbuminemia also had significantly longer lengths of stay (4.5 vs 2.1 days; P < .001). Conclusion: While complication rates after fixation of ankle fractures remain low, hypoalbuminemia was a predictor of postoperative course. Malnutrition, therefore, may help inform the decision between surgical and conservative management of patients with ankle fractures potentially amenable to nonoperative management. Additionally, hypoalbuminemia should trigger heightened awareness and prophylactic therapy where appropriate. Level of Evidence: Level III, comparative study.

scholarly journals Management of Ankle Fractures with Syndesmotic Disruption: A Survey of Orthopaedic Surgeons

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0040
Author(s):  
Ryan G. Rogero ◽  
Emmanuel M. Illical ◽  
Daniel Corr ◽  
Steven M. Raikin ◽  
James Krieg ◽  
...  
Keyword(s):  
Gold Standard ◽  
Ankle Fracture ◽  
Management Strategies ◽  
Ankle Fractures ◽  
Multinomial Regression ◽  
Orthopaedic Surgeons ◽  
Suture Button ◽  
Standard Management ◽  
Management Protocol ◽  
Usage Patterns

Category: Ankle; Trauma Introduction/Purpose: With an increasing frequency of syndesmotic fixation during ankle fracture ORIF and no current gold standard management protocol, it is important for surgeons to understand the frequency and usage patterns of the various techniques among other orthopaedic surgeons. The purposes of this study are to determine how orthopaedic surgeons currently manage ankle fractures with concomitant syndesmotic disruption and to identify surgeon demographics predictive of syndesmotic management. Methods: An 18-question survey, including 10 specific syndesmotic management questions was sent to the Orthopaedic Trauma Association (OTA) and Canadian Orthopaedic Association (COA), as well as sent to email addresses of foot and ankle-fellowship trained surgeons. Surgeon demographic questions included years, country, and type of practice, fellowship(s) completed, setting of ankle fracture surgery, and number of ankle fractures operated on per year. Multinomial regression analysis was performed to determine if surgeon demographics were predictive of syndesmotic management. Results: One-hundred ten orthopaedic surgeons completed our survey. Selected predictors of syndesmotic management included: private practice with academic appointments (0.077 [0.007, 0.834]; p=0.035) being predictive of not using screws through an ORIF plate; foot & ankle fellowship (9.981 [1.787, 55.764]; p=0.009) and trauma fellowship (6.644 [1.302, 33.916]; p=0.023) predictive of utilizing screws through a plate; no fellowship (14.886 [1.226, 180.695]; p=0.034) predictive of only using 1 screw; and surgeons practicing in the U.S. were more likely to not use screws across just 3 cortices (0.031 [0.810, 3.660]; p=0.009). Additionally, among those utilizing suture-button devices, foot & ankle fellowship-trained surgeons were more likely to implement suture-button through plate (7.676 [1.286, 45.806]; p=0.025). Conclusion: Several surgeon factors influence decision making in the management of ankle fractures with syndesmotic disruption. This study raises awareness of differences in management strategies that should be used for further discussion when determining a potential gold standard for management of these complex injuries.

scholarly journals Is postoperative non-weight-bearing necessary? INWN Study protocol for a pragmatic randomised multicentre trial of operatively treated ankle fracture

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Ramy Khojaly ◽  
Ruairí Mac Niocaill ◽  
Muhammad Shahab ◽  
Matthew Nagle ◽  
Colm Taylor ◽  
...  
Keyword(s):  
Ankle Fracture ◽  
Multicentre Trial ◽  
Short Form ◽  
Plantar Flexion ◽  
Weight Bearing ◽  
Ankle Fractures ◽  
Hospital Length Of Stay ◽  
Complication Rates ◽  
Fracture Patterns ◽  
Randomised Controlled

Abstract Background Postoperative management regimes vary following open reduction and internal fixation (ORIF) of unstable ankle fractures. There is an evolving understanding that extended periods of immobilisation and weight-bearing limitation may lead to poorer clinical outcomes. Traditional non-weight-bearing cast immobilisation may prevent loss of fixation, and this practice continues in many centres. The purpose of this trial is to investigate the safety and efficacy of immediate weight-bearing (IWB) and range of motion (ROM) exercise regimes following ORIF of unstable ankle fractures with a particular focus on functional outcomes and complication rates. Methods A pragmatic randomised controlled multicentre trial, comparing IWB in a walking boot and ROM within 24 h versus non-weight-bearing (NWB) and immobilisation in a cast for 6 weeks, following ORIF of all types of unstable adult ankle fractures (lateral malleolar, bimalleolar, trimalleolar with or without syndesmotic injury) is proposed. All patients presenting to three trauma units will be included. The exclusion criteria will be skeletal immaturity and tibial plafond fractures. The three institutional review boards have granted ethical approval. The primary outcome measure will be the functional Olerud-Molander Ankle Score (OMAS). Secondary outcomes include wound infection (deep and superficial), displacement of osteosynthesis, the full arc of ankle motion (plantar flexion and dorsal flection), RAND-36 Item Short Form Survey (SF-36) scoring, time to return to work and postoperative hospital length of stay. The trial will be reported in accordance with the CONSORT statement for reporting a pragmatic trial, and this protocol will follow the SPIRIT guidance. Discussion Traditional management of operatively treated ankle fractures includes an extended period of non-weight-bearing. There is emerging evidence that earlier weight-bearing may have equivocal outcomes and favourable patient satisfaction but higher wound-related complications. These studies often preclude more complicated fracture patterns or patient-related factors. To our knowledge, immediate weight-bearing (IWB) following ORIF of all types of unstable ankle fractures has not been investigated in a controlled prospective manner in recent decades. This pragmatic randomised-controlled multicentre trial will investigate immediate weight-bearing following ORIF of all ankle fracture patterns in the usual care condition. It is hoped that these results will contribute to the modern management of ankle fractures. Trial registration ISRCTN Registry ISRCTN76410775. Retrospectively registered on 30 June 2019.

A Retrospective Case Series of Carbon Fiber Plate Fixation of Ankle Fractures

2017 ◽  
Vol 11 (3) ◽  
pp. 223-229 ◽  
Author(s):  
Zachariah W. Pinter ◽  
Kenneth S. Smith ◽  
Parke W. Hudson ◽  
Caleb W. Jones ◽  
Ryan Hadden ◽  
...  
Keyword(s):  
Carbon Fiber ◽  
Fracture Fixation ◽  
Complication Rate ◽  
Ankle Fracture ◽  
Case Series ◽  
Complication Rates ◽  
Union Rate ◽  
Retrospective Case ◽  
Retrospective Case Series

Distal fibula fractures represent a common problem in orthopaedics. When fibula fractures require operative fixation, implants are typically made from stainless steel or titanium alloys. Carbon fiber implants have been used elsewhere in orthopaedics for years, and their advantages include a modulus of elasticity similar to that of bone, biocompatibility, increased fatigue strength, and radiolucency. This study hypothesized that carbon fiber plates would provide similar outcomes for ankle fracture fixation as titanium and steel implants. A retrospective chart review was performed of 30 patients who underwent fibular open reduction and internal fixation (ORIF). The main outcomes assessed were postoperative union rate and complication rate. The nonunion or failure rate for carbon fiber plates was 4% (1/24), and the union rate was 96% (23/24). The mean follow-up time was 20 months, and the complication rate was 8% (2/24). Carbon fiber plates are a viable alternative to metal plates in ankle fracture fixation, demonstrating union and complication rates comparable to those of traditional fixation techniques. Their theoretical advantages and similar cost make them an attractive implant choice for ORIF of the fibula. However, further studies are needed for extended follow-up and inclusion of larger patient cohorts. Levels of Evidence: Level IV: Retrospective 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.

scholarly journals Does the quality of preoperative closed reduction of displaced ankle fractures affect wound complications after surgical fixation?

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0018
Author(s):  
Bonnie Chien ◽  
Kristen Stupay ◽  
Christopher Miller ◽  
Jeremy Smith ◽  
Jorge Briceno ◽  
...  
Keyword(s):  
Classification System ◽  
Closed Reduction ◽  
Ankle Fracture ◽  
Ankle Fractures ◽  
Wound Complications ◽  
Complication Rates ◽  
Ankle Osteoarthritis ◽  
Surgical Fixation

Category: Trauma Introduction/Purpose: Prompt reduction and stabilization of displaced ankle fractures is important to protect soft tissues, restore potential neurovascular deficits and prevent cartilage injury. Many of these injuries do eventually require surgical fixation. The purpose of this study is to determine whether the initial quality of ankle closed reduction based on radiographic criteria would affect outcomes such as ankle osteoarthritis and complications after surgery. Furthermore, we sought to develop a classification system for the quality of closed reduction that would be easy to use and provide interrater reliability. Methods: A retrospective analysis of patients who sustained isolated, closed ankle fractures with at least 3 months follow up postoperatively at two level 1 trauma centers was performed. Patient demographics and history, ankle fracture characteristics and reduction information as well as surgical outcomes and complications were collected. A grading classification for the quality of the initial closed reduction before surgery was developed based on standard AP or mortise and lateral ankle x-rays. The factors considered for rating the reduction included the degree of talar shift on the AP/mortise view, malleoli displacement, as well the relationship of a central plumb line to the center of the talar dome on the lateral x-ray. For ankle osteoarthritis, the Takakura classification was utilized. Three reviewers (1 resident, 2 attendings) independently reviewed and rated all imaging. Results: 161 patients were analyzed. 65% female, average age 50, average 4 days between injury and surgery, mean follow up of 12 months (3-58 months), and 17% wound complications. Psychiatric history was the single comorbidity significantly associated with complications (p=0.009). There was no difference in wound or infection complication rates based on initial closed reduction quality (p=0.17). Neither number nor quality of reductions correlated with increased osteoarthritis (p=0.19, 0.39 respectively). Worst graded reductions had shorter time to surgery, mean 1.4 vs 4.7 days for best reductions (p=0.03), suggesting a protective factor that may account for no association between reduction quality and wound complications. Interclass correlation coefficients for multiple observers showed very high consistency for grading of reduction quality based on the classification system (ICC >0.85, p<0.001). Conclusion: It is often emphasized that a displaced ankle fracture should be as perfectly reduced as possible, understandably for grossly dislocated ankle fracture dislocations potentially compromising skin and neurovascular structures. At the same time, this original study demonstrated contrary to common assumption that the initial quality of ankle closed reduction does not appear to affect the severity of ankle osteoarthritis or the rate of surgical complications. This study also developed a highly reproducible ankle reduction classification system. It opens the opportunity for future prospective application and analysis of this classification’s ultimate clinical utility.

Sign in / Sign up

Export Citation Format

Share Document