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.

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.

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

2019 ◽  
Vol 58 (3) ◽  
pp. 470-474 ◽  
Author(s):  
Jennifer W. Liu ◽  
Junho Ahn ◽  
Katherine M. Raspovic ◽  
George T. Liu ◽  
Paul A. Nakonezny ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Internal Fixation ◽  
Open Reduction ◽  
Ankle Fractures

scholarly journals Diabetic Ankle Fracture Complications: A Meta-Analysis

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0028
Author(s):  
Laia Lopez-Capdevila ◽  
Juan Manuel Rios Ruh ◽  
Jorge Fortuño Vidal ◽  
Andres Eduardo Costa ◽  
Mario Alexandre Sanchez Mata ◽  
...  
Keyword(s):  
Ankle Fracture ◽  
Meta Analysis ◽  
Patient Characteristics ◽  
Postoperative Management ◽  
Ankle Fractures ◽  
Diabetic Patients ◽  
Charcot Neuroarthropathy ◽  
Non Union ◽  
Major Complications ◽  
Increased Risk

Category: Ankle, Diabetes, Trauma Introduction/Purpose: Fractures in diabetic patients have a well-known increased risk of complications and this makes the decision to treat these fractures either surgically or conservatively a difficult choice. However, ankle fractures are mostly treated surgically because of their pattern and the postoperative management does not differ from those ankle fractures in non-diabetic patients. The following study aims to review the evident rate of complications following the treatment of an ankle fracture in diabetic patients and their matched controls. Methods: Searches of PubMed, Scopus, Cochrane and ISI Web of Knowledge were performed for studies published between the date of database inception and March 2018. An initial selection of 202 abstracts was performed by at least 2 different reviewers, of which 77 articles were selected to complete review. After following strict inclusion and exclusion criteria, only 17 papers were admitted to the final meta-analysis. Demographics patient characteristics and incidence of the overall and specific complications were extracted from each study selected and an odds ratio with a 95% confidence interval of each complication was calculated between the diabetic and non- diabetic groups. Major complications (infection, non-union, malunion, Charcot neuroarthropathy, amputation, death) were compared not only between the two main groups but also between subgroups (complicated diabetic and non-complicated diabetic patients, surgical and orthopaedic treatment). The statistics data was analysed by Stata 15. Results: There is a significant increased rate of complications after treating an ankle fracture orthopaedically or surgically in diabetic patients (OR 1.74, IC 95% 1.67 to 1.82). This risk is considerably higher when the ankle fracture is treated surgically (OR 5.14, IC 95% 2.79 -9.58). Among the complications in diabetic patients, the rate is greater in complicated diabetic patients (neuropathy, vasculopathy) compared to the non-complicated diabetic patients (OR 8, IC 95% 2.61 - 26.31). The main complication postoperative in ankle fracture described is infection, which is 7 times higher in diabetic patients in comparison to non-diabetic patients (OR 6.9, IC 95% 3.03 -15.73). The risk of amputation and/or non-union after an ankle fracture in diabetic patients is about 0.2%. Conclusion: This meta-analysis provides evidence that diabetic patients have a significant greater risk of presenting a complication after an ankle fracture. The rate of major complications (infection, malunion, non-union, amputation and death) is by far significantly higher among those diabetic patients treated surgically and even greater among complicated diabetic patients.

scholarly journals Clinical Outcome of Bimalleolar Ankle Fracture in Patients with Diabetes Mellitus

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0032
Author(s):  
Hong S. Lee ◽  
Kiwon Young ◽  
Tae-Hoon Park ◽  
Hong Seop Lee
Keyword(s):  
Diabetes Mellitus ◽  
Clinical Outcome ◽  
Internal Fixation ◽  
Ankle Fracture ◽  
Open Reduction ◽  
Outcome Analysis ◽  
Charcot Arthropathy ◽  
Union Rate ◽  
Patients With Diabetes ◽  
Fracture Surgery

Category: Trauma; Ankle Introduction/Purpose: Diabetes is a risk factor of postoperative complication for fracture surgery. The purpose of this study was to evaluate the clinical outcome of bimalleolar ankle fracture in patients with diabetes mellitus. Methods: Twenty two patients (an average age; 69.3 years, an average HbA1C; 7.6%) with bi-malleolar ankle Fracture received open reduction and internal fixation between March 2013 and January 2019. Complications related to surgery, progression to Charcot arthropathy, presence of nonunion were used for outcome analysis. The patients were followed for an average of 12.1 months. Results: The nonunion rate was 4.5% (1 case over 22 cases). The incidence rate of Charcot arthropathy was 4.5% (1 case over 22 cases). The patient with Charcot arthropathy was conversed to the tibiotalarcalcaneal fusion with retrograde intramedullary nail. No wound infection or soft tissue complications related to surgery was reported. Conclusion: Standard open reduction and internal fixation technique showed high union rate of bimalleolar ankle fracture in patients with diabetes mellitus. The surgeon should be cautious to the Charcot arthropathy when treating ankle fracture with diabetes mellitus.

scholarly journals Risk Stratification for Ankle Fracture Complications in Diabetic Patients

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0025
Author(s):  
Kenneth Hunt ◽  
Daniel Moon ◽  
Joseph Morales ◽  
Amy Harlow
Keyword(s):  
Logistic Regression ◽  
Ankle Fracture ◽  
Major Complication ◽  
Wound Complication ◽  
Ankle Fractures ◽  
Diabetic Patients ◽  
Factors Associated ◽  
Major Complications ◽  
Increased Risk ◽  
Patients With Diabetes

Category: Diabetes Introduction/Purpose: While diabetes is a well-known risk factor for morbidity following surgical fixation of ankle fractures, it is likely that increased risk is related to specific diabetes-associated comorbidities. Compared to patients with uncomplicated diabetes, patients with complicated diabetes have higher risks of infection, overall complications, and a higher likelihood of needing revision surgery/arthrodesis. This suggests that the presence and severity of specific risk factors may help predict post-operative risks for diabetic ankle fracture patients and help guide treatment decisions. To date, no study has identified specific diabetes-associated factors and comorbidities which can pose an increased risk of complications for diabetic ankle fracture patients. We hypothesized that patients with diabetes-related comorbidities will suffer significantly more major complications following surgery for unstable ankle fractures compared to uncomplicated diabetics. Methods: We retrospectively reviewed all patients with diabetes treated surgically for ankle fracture at a University medical center over a 12-year period, examining patient and fracture characteristics, treatment method, and clinical and laboratory factors associated with complications. Outcome variables include time to union, wound complication, infection, hardware failure, and need for additional surgery following injury. The primary outcome was major complication, defined as the presence of one or more of the following: deep infection (as evidenced by hardware removal or I&D), amputation, malunion or non-union, skin graft, or wound complication (as evidenced by infection or dehiscence). Bivariate analyses and logistic regression were used to examine the relationships between specific complications and various clinical and demographic factors. A p-value of < 0.05 denotes statistical significance. Results: A total of 61 patients met inclusion criteria. Patient characteristics are depicted in Table 1. Bivariate analyses showed that when compared to diabetic patients without complications, patients who experienced major complications had a significantly higher rate of renal disease (p = 0.032) and retinopathy (p = 0.020), and significantly more hospital readmissions (p < 0.001). Factors associated with complications were determined by a logistic regression model. Age, sex, race, tobacco use and HgbA1C were not associated with increased risk of major complications. However, for each 1-unit increase in the Charlson Comorbidity Index (CCI) Score, there was a 40.6% increase in the likelihood of major complication among diabetic patients with ankle fractures (p = 0.025). Conclusion: Patients with diabetes-related comorbidities have a significantly higher risk of experiencing major complications following treatment of unstable ankle fractures. In this cohort, renal disease, retinopathy and higher CCI were found to be significantly associated with major complications. Interestingly, neuropathy, smoking, and HgA1C were not independent predictors of major complications in this cohort. These data will inform a multi-center prospective registry of patients with diabetes and ankle fractures, and ultimately the development of a risk tool to help guide clinical decision-making and post-operative care for diabetic patients at risk of major complication, re-admission, or re-operation following treatment for ankle fractures.

scholarly journals Timing of Open Reduction and Internal Fixation of Ankle Fractures

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.

scholarly journals RISK FACTORS OF LOW-ENERGY FRACTURES IN PATIENTS WITH TYPE 2 DIABETES MELLITUS

2018 ◽  
Vol 25 (4) ◽  
pp. 115-123
Author(s):  
G. M. NURULLINA ◽  
G. I. AKHMADULLINA ◽  
O. V. KRASNOPEROVA ◽  
M. M. ALEKSEEVA ◽  
O. V. ALEKSANDROVA ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Large Scale ◽  
Osteoporotic Fractures ◽  
Diabetic Patients ◽  
Social Significance ◽  
Mineral Density ◽  
Increased Risk ◽  
Long Time ◽  
Risk Of Falls

Osteoporosis is a metabolic disease of the bone tissue, which is characterized by a violation of the qualitative (microarchitecture  change) and quantitative characteristics (decreased bone mass) of  the skeleton, and, as a result, lowenergy fractures. The medical and  social significance of osteoporosis is due to its consequences:  fractures of the femoral neck, vertebral bodies, radius and other  large bones of the skeleton, which significantly reduces the quality of patients’ lives and entails significant financial costs for treatment and rehabilitation.  Prevalence of diabetes mellitus (DM) significantly  increases in all countries of the world, including the Russian  Federation. Diabetes and osteoporosis were considered to be  individual diseases for a long time. In many prospective large-scale studies it was proved that patients with T2DM have a greater risk of  falls and fractures in contrast with the overall population. Despite the increased risk of fractures in diabetic patients, there is still no risk  stratification in these patients. The link between the classic risk  factors of osteoporotic fractures (such as chronic intake of  glucocorticoids, use of alcohol, tobacco, etc.) and the occurrence of  fractures is similar in patients with both T2DM and without it.  However, it is necessary to take into account other characteristics of  diabetes. The specific risk factors of fractures in T2DM patients are  duration of the diabetes for more than 10 years, diabetes decompensation, the severity of diabetes, obesity, the frequency of  falls, hypoglycemia, insulin, thiazolidinedione, exenatide, sulfonylureas, canagliflozin therapy, and, most likely, the reduction  of 25 (OH) vitamin D, functional hypoparathyroidism, the increase of sclerostin, pentosidine, decreased bone mineral density (BMD) of the hip.

scholarly journals Postoperative Complications Following Ankle Fractures in the Geriatric Population: A Case Series

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0009
Author(s):  
Matthew Anderson ◽  
Aaradhana J. Jha ◽  
Sameer M. Naranje ◽  
Gean C. Viner ◽  
Haley McKissack ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Internal Fixation ◽  
Revision Surgery ◽  
Open Reduction ◽  
Illicit Drugs ◽  
Standard Procedure ◽  
Case Series ◽  
Ankle Fractures ◽  
Increased Risk

Category: Ankle, Trauma Introduction/Purpose: Ankle fractures are among the most common orthopedic injuries. While open reduction and internal fixation (ORIF) is the standard treatment for displaced ankle fractures in younger patients, there is controversy regarding the optimal management of these injuries among geriatric patients due to the high prevalence of comorbidities. Closed manipulation leads to poor long-term functional outcomes, with high rates of malunion and non-union in all populations as well as higher mortality in patients over 65 years of age. However, surgical management in the elderly carries rates of complications as high as 20-40%. The purpose of this study was to investigate risk factors for healing complications following ORIF of ankle fractures in patients greater than 75 years of age. Methods: All patients 75 years of age and older undergoing open reduction and internal fixation of ankle fractures at a single institution from 2008 to 2018 were identified. Patients with polytrauma and/or pilon fractures were excluded. Patient medical records were reviewed to obtain information regarding details about the injury, surgery, and follow-up as well as patient demographics and comorbidities. Radiographs from post-operative clinic visits were examined by a foot and ankle certified orthopedic fellow for each patient and the time for complete union was recorded as well as any delayed union or malunion. Fisher’s exact tests were used to compare post-operative complications (wound infection, wound dehiscence, sepsis, deep vein thrombosis, revision surgery, and malunion/nonunion) among those with and without specific comorbidities. Results: Patients with other comorbidities had a statistically significant increased risk of revision surgery (p<0.0001). Additionally, those who used illicit drugs had statistically significant increased risk of sepsis (0.0213). Revision surgeries included syndesmotic screw removal, a standard procedure which does not necessarily imply presence of complication. Conclusion: Elderly patients are susceptible to various postoperative complications. Substance abuse is associated with revision surgery, while the presence of other comorbidities collectively is associated with sepsis. To optimize postoperative management, surgeons should be aware of patient comorbidities and exceptionally attentive at follow-up examinations for these patients.

scholarly journals Surgical Site Infections Following Open Reduction and Internal Fixation of Ankle Fractures

2009 ◽  
Vol 3 (1) ◽  
pp. 56-60 ◽  
Author(s):  
T Thangarajah ◽  
P.S.V Prasad ◽  
B Narayan
Keyword(s):  
Internal Fixation ◽  
Fracture Fixation ◽  
Ankle Fracture ◽  
Open Reduction ◽  
Surgical Site Infections ◽  
Perioperative Period ◽  
Fracture Pattern ◽  
Ankle Fractures ◽  
Exact Test ◽  
Patients At Risk

Background:Ankle fracture fixation is one of the most commonly performed orthopaedic procedures. Although the results are generally favourable, complications are not uncommon, particularly in the case of surgical site infections. These have considerable impact on both postoperative morbidity and healthcare costs. Paradoxically, there is a paucity of literature studying patients who sustain them and therefore little is known about ways such occurrences can be minimised. The purpose of this study was to determine the infection rate following ankle fracture fixation and elucidate variables in their causation.Methods:We retrospectively reviewed 50 consecutive patients who underwent open reduction and internal fixation of an ankle fracture. The study group consisted of 26 females and 24 males with an average age of 43 (Range 16-82) years.Results:Problems with superficial infections were noted in seven patients and deep infections in five. Of the latter, four patients underwent further surgery including two that had their metal work removed. With use of the Fisher’s exact test we determined that only smoking and a bimalleolar fracture pattern were significant variables, having p-values of 0.02 and 0.04 respectively.Conclusion:We recommend that patients with ankle fractures who either have a history of smoking and/or bimalleolar injury be counselled about the potential risk of infection and its implications on their functional recovery. The ability to identify patients at risk of such problems highlights the need for caution during the perioperative period so that care strategies may be altered to facilitate recovery.

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