scholarly journals Are Orthopaedic Surgeons Being Adequately Compensated for Ankle Fractures? An Analysis of Relative Value Units (RVUs)

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0005
Author(s):  
Azeem Tariq Malik ◽  
Safdar N. Khan ◽  
Laura Phieffer ◽  
Thuan V. Ly ◽  
Carmen E. Quatman
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Operative Time ◽  
Open Reduction Internal Fixation ◽  
Ankle Fractures ◽  
Reimbursement Rate ◽  
Total Operative Time ◽  
Orthopaedic Surgeons ◽  
Malleolar Fractures ◽  
The Mean

Category: Ankle, Trauma Introduction/Purpose: Tri-malleolar fractures, as compared to simple uni-malleolar fractures, are technically more challenging cases, have longer operative times and require a higher effort. The current RVU-based system is built to reflect the varying presentation of ankle fractures (uni-malleolar vs. bi-malleolar vs. tri-malleolar) by assigning individual RVUs to different fracture complexities. However, no study has evaluated whether the current RVUs reflect an appropriate compensation per unit time following open reduction internal fixation (ORIF) for uni-malleolar vs. bi-malleolar vs. tri-malleolar ankle fractures. Methods: The 2012-2017 American College of Surgeons – National Surgical Quality Improvement Program (ACS-NSQIP) files were queried using CPT codes for patients undergoing open reduction internal fixation (ORIF) for uni-malleolar (CPT-27766, CPT- 27769, CPT-27792), bi-malleolar (CPT-27814) and tri-malleolar (CPT-27822, CPT-27823) ankle fractures. A total of 7,830 (37.2%) uni-malleolar, 7,826 (37.2%) bi-malleolar and 5,391 (25.6%) tri-malleolar ankle fractures were retrieved. Total RVUs were calculated for each case. Mean RVU/minute was derived by dividing the total RVU of each case by the total operative time. Reimbursement rate ($/min) was calculated by multiplying the mean RVU/min of each procedure by a preset CMS-defined rate of $35.8887/RVU. Mean Reimbursement/case was calculated by multiplying the reimbursement rate by the operative time of each procedure. Kruskal-Wallis tests were used to compare RVUs, operative time and reimbursements between the three fracture groups. Results: The mean total RVU for each fracture type was as follows:- 1) Uni-malleolar: 9.99, 2) Bi-malleolar=11.71 and 3) Tri- malleolar=12.87 (p<0.001). A statistically significant difference was noted in mean operative time (uni-malleolar=63.2 vs. bi- malleolar=78.6 vs. tri-malleolar=95.5; p<0.001) between the two groups. Reimbursement rates ($/min) decreased significantly as fracture complexity increased (uni-malleolar=$7.21/min vs. bi-malleolar=$6.75/min vs. tri-malleolar=$6.10; p<0.001). The average reimbursement/case was $358, $420 and $462 for uni-malleolar, bi-malleolar and tri-malleolar fractures respectively. Based on a hypothetical scenario, an orthopaedic surgeon spent 190 minutes fixing two tri-malleolar fractures and earning $924 in the process. Within a total operative time of 190 minutes, three uni-malleolar ankle fractures and two bi-malleolar ankle fractures could be managed completely with an associated earning of $1,074 and $840 respectively. Conclusion: Orthopaedic surgeons are reimbursed at a higher rate ($/min) for treating a simple uni-malleolar fracture as compared to bi-malleolar and tri-malleolar fractures, despite the higher complexity and longer operative times seen in the latter. The study highlights the need of a change in the RVUs for bi-malleolar and tri-malleolar ankle fractures to ensure that surgeons are adequately reimbursed per unit time for treating a more complex fracture case.

MALLEOLAR ANKLE FRACTURES IN ADULTS: FUNCTIONAL OUTCOME AND COMPLICATIONS AFTER OPEN DECREASE AND INTERNAL FIXATION

2020 ◽  
Vol 4 (3) ◽  
Author(s):  
Chetan Laljibhai Rathod
Keyword(s):  
Internal Fixation ◽  
Functional Outcome ◽  
Open Reduction ◽  
External Rotation ◽  
Ankle Fractures ◽  
Ankle Injuries ◽  
Excellent Outcome ◽  
Malleolar Fractures ◽  
Supination External Rotation ◽  
Type Of Injury

Background: Ankle injuries may result from high energy as well as low energy rotational forces sustained during sports or a misstep during routine daily activities.3 Young and middle aged are more prone for this type of injury. Population-based studies suggest that the incidence of the ankle fractures has increased dramatically since the early 1960s. Objective: To evaluate the functional outcome and complications following open reduction and internal fixation of malleolar fractures of ankle in adults. Methodology: The study was a descriptive observational study conducted involving all the adult patients of malleolar fractures. Total of 35 subjects of malleolar fractures undergoing open reduction and internal fixation and fulfilling the eligibility criteria were selected for the study. Results: 31.4% subjects each were from 31-40 and 41-50 years age group with mean age of 39.32 +/- 4.16 years. 37.1% patients had Supination External Rotation and 34.3% patients had Pronation External Rotation type of injury. 82.9% patients had Bi-malleolar fracture. 11(31.4%) patients had excellent outcome. Post-operative complications included superficial skin infections in 17.1% and Ankle stiffness in 5.7% cases. Conclusion: At the end of 6 months, 11(31.4%) patients had excellent outcome, 19(54.3%) had good results, 3 (8.6%) patients had fair outcome while 2 (5.7%) had poor results according to Baird and Jackson score. Weber type B was the commonest type of fracture while supination external rotation injury was the most common mechanism of injury. Keywords: Malleolar fractures, ankle, adults, functional outcome, complications, open reduction and internal fixation.

scholarly journals Treatment of Ankle Fractures with Open Reduction Internal Fixation via Improved Posterolateral Incision

2015 ◽  
Vol 7 (3) ◽  
pp. 288-289
Author(s):  
Ju-zheng Hu ◽  
Zhan-ying Shi ◽  
Jing-li Tang ◽  
Cheng-ming Zhu
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Open Reduction Internal Fixation ◽  
Ankle Fractures

The Use of Dual C-Arms During Fixation of Calcaneal Fractures

2013 ◽  
Vol 7 (3) ◽  
pp. 207-209 ◽  
Author(s):  
Mostafa M. Abousayed ◽  
Rull James Toussaint ◽  
John Y. Kwon
Keyword(s):  
Internal Fixation ◽  
Expert Opinion ◽  
Open Reduction ◽  
Operative Time ◽  
Simple Technique ◽  
Intraoperative Imaging ◽  
Arm Movement ◽  
Open Reduction Internal Fixation ◽  
Calcaneal Fractures ◽  
Lateral Decubitus

We describe a simple technique using dual C-arms (large and mini C-arm together) for open reduction internal fixation of calcaneal fractures in the lateral decubitus position that (1) decreases the difficulty of obtaining proper intraoperative imaging; (2) limits C-arm movement, which decreases risk of contamination and operative time; and (3) minimizes the drawbacks of each imaging fluoroscopic modality. Levels of Evidence: Level V, Technical tip, Expert opinion

scholarly journals Functional Outcome of Traumatic Acetabulum Fractures : A 6 Months Comprehensive Follow Up Following Open Reduction Internal Fixation Surgery at Saiful Anwar General Hospital Malang

2020 ◽  
Vol 8 (5_suppl5) ◽  
pp. 2325967120S0003
Author(s):  
DP Putra ◽  
AS Pradana ◽  
KY Phatama ◽  
E Mustamsir ◽  
M Hidayat
Keyword(s):  
Internal Fixation ◽  
Functional Outcome ◽  
General Hospital ◽  
Open Reduction ◽  
Open Reduction Internal Fixation ◽  
Harris Hip Score ◽  
Acetabular Fractures ◽  
Acetabulum Fractures ◽  
Harris Score ◽  
The Mean

Acetabular fractures commonly occurred in young adult patient who suffered from high impact trauma which often associated with life threatening injuries. Displaced acetabular fractures lead to abnormal distribution on joint cartilage pressures. It produces early cartilage disruption and development of premature osteoarthritis at the hip. Anatomical reduction and fixation operation in acetabulum fractures still a major challenges due to its complications such as poor functional outcome after surgery. Despite its difficulty to predict the outcomes of acetabular fractures surgeries, functional outcomes scoring such as Oxford Hip Score (OHS) and Harris score may help surgeon to measure long term outcome following acetabular fractures. A total of 13 patients were treated over period of January 2018 until March 2019 in Saiful Anwar General Hospital Malang. The mean age of patients in this serial case is 37 years old and were operated within 2 weeks of injury. All the patients undergone an ORIF (Open Reduction Internal Fixation) operation and observed for the OHS and also Harris score 6 months following surgeries to measure functional outcome of the patients. The mean score of OHS in this serial case is 41 (satisfactory joint function) and the mean score of harris hip score is 91 (excellent). Some patients experience pain during activities, tingling sensation after standing in some periods of time, and heaviness when taking stairs 6 months after operation. This results conclude that the preoperative, operative and post operative management of patient with acetabular fracture in Saiful Anwar Hospital has satisfactory results.

scholarly journals Timing of Adverse Events Following Open Reduction and Internal Fixation of the Ankle

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0016
Author(s):  
Daniel Bohl ◽  
Simon Lee ◽  
Kamran Hamid ◽  
Johnny Lin ◽  
George Holmes
Keyword(s):  
Myocardial Infarction ◽  
Adverse Events ◽  
Internal Fixation ◽  
Open Reduction ◽  
Kidney Injury ◽  
Interquartile Range ◽  
Improvement Program ◽  
Orthopaedic Surgeons ◽  
Vein Thrombosis ◽  
Malleolar Fractures

Category: Ankle Introduction/Purpose: There is increasing interest in the early identification and treatment of adverse medical events following orthopaedic procedures. The purpose of this study is to characterize the timing of adverse events following open reduction and internal fixation of closed fractures of the ankle. Methods: A retrospective cohort study was conducted using the American College of Surgeons National Surgical Quality Improvement Program. A total of 17,318 patients undergoing open reduction and internal fixation of closed ankle fractures were identified. For each of eight different adverse events, the median postoperative day of diagnosis, interquartile range for day of diagnosis, and middle 80% for day of diagnosis were determined. Timing was compared between uni-malleolar and bi-/tri-malleolar fractures. Results: The median day of diagnosis (and interquartile range; middle 80%) for myocardial infarction was 2 (1-5; 0-17), pneumonia 3 (2-7; 1-19), acute kidney injury 6.5 (2-18; 2-20), urinary tract infection 7 (2-14; 0-24), pulmonary embolism 10 (3-21; 0-27), sepsis 15 (4-22; 1-28), deep vein thrombosis 17 (10-22; 3-27), and surgical site infection 19 (14-25; 8-28; Figure 1). Myocardial infarction occured earlier in patients with bi-/tri-malleolar fractures than in patients with uni-malleolar fractures (median postoperative day 2 versus 10, p=0.041). Similarly, sepsis occured earlier in patients with bi-/tri-malleolar fractures than in patients with uni-malleolar fractures (median day 10 versus 20.5, p=0.022). For the other 6 adverse events, there was no difference in timing between patients with uni-malleolar and patients with bi-/tri-malleolar fractures (p>0.05 for each). Conclusion: These precisely described time periods for occurrence of specific adverse events enable heightened awareness amongst orthopaedic surgeons during the first month following open reduction and internal fixation of the ankle. Orthopaedic surgeons should have the lowest threshold for testing for each adverse event during the time period of greatest risk.

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 Open reduction internal fixation with triceps-sparing approach in distal humerus fracture: an experience from a tertiary level hospital in Mangalore

2019 ◽  
Vol 5 (2) ◽  
pp. 345
Author(s):  
Bhaskar Bhandary ◽  
Sachin Shetty ◽  
Mohammed Shabir Kassim ◽  
Amlan Mohapatra
Keyword(s):  
Internal Fixation ◽  
Range Of Motion ◽  
Open Reduction ◽  
Final Analysis ◽  
Distal Humerus ◽  
Open Reduction Internal Fixation ◽  
Range Of Movement ◽  
Humerus Fractures ◽  
The Mean ◽  
Distal Humerus Fractures

<p class="abstract"><strong>Background:</strong> Fractures of the distal humerus represent challenging problems to an orthopaedic surgeon. The present study aimed to assess the range of movement after performing open reduction and internal fixation of distal humerus fractures treated with triceps sparing approach.</p><p class="abstract"><strong>Methods:</strong> This prospective study included all skeletally mature patients with distal humerus fractures and operated at our center with open reduction and internal fixation of distal humerus with triceps on or triceps sparing approach were included in the study. During the study period 30 cases underwent surgery and were included in the final analysis. Fractures were classified according to the AO/OTA classification. Patients will be followed up at 6 weeks, 12 weeks and at 6 months. Mean range of motion of the fractured elbow at different follow up points were compared.<strong></strong></p><p class="abstract"><strong>Results: </strong>The mean age of the total population was 37.7±13.8 years, 57% males and left side was affected in 60% of the patients. Majority of the patients had a range of motion in normal elbow in the range 0 to 140 degrees. There was an increase in the mean range of movement from 63.4±14.2 at 6<sup>th</sup> week to 120±6 at 24<sup>th</sup> week, and this change was statistically significant (p&lt;0.001).</p><p class="abstract"><strong>Conclusions:</strong> Future multicentric randomized studies, specially comparing triceps-sparing with olecranon osteotomy, are needed to support the results of our study.</p>

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