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 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.

The Foot and Ankle Outcome Score (FAOS) During Early Recovery After Ankle Fracture

2021 ◽  
pp. 107110072110028
Author(s):  
Peter Larsen ◽  
Mohammed Al-Bayati ◽  
Rasmus Elsøe
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Ankle Fracture ◽  
Minimal Clinically Important Difference ◽  
Ankle Fractures ◽  
Foot And Ankle ◽  
Early Recovery ◽  
Clinically Important Difference ◽  
Test Retest Reliability

Background: Several patient-reported outcome measures (PROMs) are available for assessing the outcomes following ankle fractures. This study aimed to evaluate validity, reliability, and responsiveness and detect the minimal clinically important difference of the Foot and Ankle Outcome Score (FAOS) in patients with ankle fractures. Methods: The study design is a prospective cohort study, including all patients treated both conservatively and surgically following an ankle fracture (AO-43A/B/C). Content validity, test-retest reliability, responsiveness, and minimal clinically important difference were evaluated from 14 days to 3 months following the fracture. Results: The study population consisted of 52 females and 24 males. The mean age was 52.0 years (range, 15-75 years). The percentage of patients at 12 weeks reporting the 5 subscales at least somewhat relevant were pain, 77%; symptoms, 75%; activities of daily living (ADL), 64%; sport, 81%; and quality of life (QOL), 88%. High test-retest reliability of the FAOS questionnaire was observed. The interclass coefficients were 0.78, 0.77, 0.71, 0.73, and 0.74 for the pain, symptoms, ADL, sport, and QOL subscales, respectively. Responsiveness was evaluated with high effect size for the symptoms (0.83), ADL (1.19), sport (4.36), and QOL (2.12) subscales. The minimal clinically important difference of the FAOS was 14 (95% CI, 12-17). Conclusion: The FAOS during early recovery after ankle fracture has high reliability and validity. Level of Evidence: Level II, prospective cohort study

scholarly journals Predictors of early complications following surgical treatment of geriatric ankle fracture

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
Seung-Myung Choi ◽  
Byung-Ki Cho
Keyword(s):  
Surgical Treatment ◽  
Glycemic Control ◽  
Wound Infection ◽  
Ankle Fracture ◽  
Chronic Renal Disease ◽  
Multiple Logistic Regression Analysis ◽  
Serum Glucose ◽  
Ankle Fractures ◽  
Major Complications ◽  
Geriatric Ankle Fracture

Category: Ankle, Diabetes, Trauma Introduction/Purpose: Factors predicting complications after surgical treatment of geriatric ankle fractures include presence of various comorbidities such as diabetes, chronic renal disease. However, beyond the binary definition of presence or absence, further speci? c information of these comorbidities such as their chronicity, severity and/or perioperative laboratories have not been studied as risk factors for postoperative complications. The purpose of this study is to investigate the association between the measurements of comorbidities and complications within the? rst 30 days following surgical treatment of geriatric ankle fracture. Methods: A retrospective cohort study. From 2000 to 2015, we collected patient demographics, comorbidities-related data including laboratory values and complications within 30 days following open reduction and internal fixation of low energy ankle fractures in patients older than 65 years. Multiple logistic regression analysis was performed to determine factors affecting minor (super? cial wound infection, delayed wound healing, urinary tract infection, pneumonia), major complications (deep wound infection, loss of? xation, deep venous thrombosis, organ/space failure). Results: In total, 1,358 patients were included for analysis. The average age was 70.54 years (SD, 7.40). There were 895 (66%) females and 463 (34%) males. Baseline glucose concentrations >200 mg/dL (p < 0.001) and the mean 48 hour postoperative serum glucose concentrations >150 mg/dL (p < 0.001), history of taking wound compromising medications (p = 0.003) were signi? cantly associated with minor complications. Preoperative glycated hemoglobin (HbA1c) >6.5% (p < 0.001), estimated glomerular? ltration rate (eGFR) <45 mL/min/1.73 m2 (p < 0.001), dependent functional status and presence of two or comorbidities (p < 0.001) were statistically associated with major complications. Conclusion: poor glycemic control in the perioperative period, wound-compromising medications were associated with increased rates of minor complications, whereas poor chronic glycemic control (HbA1c), decreased renal function and vulnerability with multiple comorbid conditions were associated with major complications. Perioperative blood glucose management may prevent minor complications, whereas and mean serum glucose concentrations of 150 mg/dL and higher during this time period

scholarly journals Role of Arthroscopy in Ankle Fracture Surgery

2019 ◽  
Vol 7 (11_suppl6) ◽  
pp. 2325967119S0045
Author(s):  
Jae Hoon Ahn
Keyword(s):  
Internal Fixation ◽  
Ankle Fracture ◽  
Postoperative Outcome ◽  
Persistent Pain ◽  
Ankle Arthroscopy ◽  
Ankle Fractures ◽  
Definitive Treatment ◽  
Syndesmosis Injury ◽  
Poor Outcomes

The ankle arthroscopy is widely used as an essential tool for the various ankle disorders. The use of arthroscopy has also been tried for the treatment of acute ankle fractures, in the hope of improving the postoperative outcome. It was initially thought that the properly reduced ankle fractures had generally acceptable outcomes, with a reported rate of 81% good to excellent results. However further investigation and longer term follow-up has shown more mixed and less encouraging results. Some patients have persistent pain and poor outcomes following open reduction and internal fixation (ORIF), although the cause of poor outcome is not clearly understood. It may be secondary to intra-articular injuries at the time of fracture, which occur in up to 88% of fractures. Ankle arthroscopy at the time of ORIF has been proposed to address these intraarticular injuries. Arthroscopy-assisted reduction and percutaneous screw fixation for syndesmosis injury has been performed as well by some surgeons. However the effectiveness of true arthroscopic reduction and internal fixation compared with ORIF for ankle fractures has yet to be determined, in spite of the advantages such as limited exposure, preservation of blood supply, and improved visualization of the pathology. Postoperative chronic pain and arthrofibrosis after ankle fracture are another good indication for ankle arthroscopy, which can be performed at the time of implant removal. In conclusion, the ankle arthroscopy is a safe adjunctive procedure for the treatment of ankle fractures. It can be performed as well for the evaluation and management of syndesmotic injury, and for persistent pain following the definitive treatment of ankle fractures.

Postoperative Outcomes for Plate-Screw Fixation in Adolescent Patients with Ankle Fracture

2020 ◽  
Vol 110 (6) ◽  
Author(s):  
Mehmet Ali Talmaç ◽  
Mehmet Akif Görgel ◽  
Yusuf Yahşi ◽  
Muharrem Kanar ◽  
Ali Seker ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Ankle Fracture ◽  
Screw Fixation ◽  
High Energy ◽  
Low Energy ◽  
Ankle Fractures ◽  
Postoperative Outcomes ◽  
Trauma Patients ◽  
High Energy Trauma ◽  
Adolescent Patients

Backround We compared postoperative outcomes in adolescent patients who did and did not undergo plate-screw fixation of at least one of the lateral, medial, or posterior malleoli in ankle fractures. It was hypothesized that using plate-screw fixation would not negatively affect postoperative outcomes. Methods All of the preoperative data and postoperative outcomes for 56 patients with ankle fractures aged 12 to 15 years who underwent surgical treatment between January 1, 2007, and December 31, 2017, were reviewed retrospectively. Patients were grouped into plate-screw fixation (n = 15) and non–plate-screw fixation (n = 41) groups and as high- and low-energy trauma patients. Results There were no significant differences in postoperative outcomes between the plate-screw fixation and non–plate-screw fixation groups. The mean American Orthopaedic Foot & Ankle Society score of high-energy trauma patients was significantly lower than that of low-energy trauma patients (P &lt; .001), and the rate of degenerative change in high-energy trauma patients was significantly higher than that in low-energy trauma patients (P = .008). There were no significant differences between high- and low-energy trauma patients with respect to other postoperative outcomes. Conclusions If anatomical reduction is performed without damaging the growth plate, postoperative clinical outcomes may be near perfect regardless of screw-plate fixation use. Postoperative outcomes of adolescent ankle fracture after high-energy trauma, independent of Salter-Harris classification and surgical treatment methods, were negative.

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.

scholarly journals Estudo descritivo sobre o financiamento da assistência à saúde frente ao tratamento cirúrgico de fratura do tornozelo e retirada de placas/parafuso em Belo Horizonte, Minas Gerais, Brasil, 2014–2019

2021 ◽  
Vol 21 (82) ◽  
Author(s):  
Pedro Sebastião De Oliveira Lazaroni ◽  
Luciana Alves Silveira Monteiro ◽  
Alesson Filipi Bernini ◽  
Gustavo Damazio Heluy
Keyword(s):  
Health Care ◽  
Surgical Treatment ◽  
Ankle Fracture ◽  
Health Care Financing ◽  
Descriptive Study ◽  
Minas Gerais ◽  
Ankle Fractures ◽  
Ankle Injuries ◽  
Belo Horizonte ◽  
Ankle Dislocation

Objetivo: descrever as internações e os custos hospitalares por tratamento cirúrgico de fratura do tornozelo unimaleolar; por tratamento cirúrgico de fratura do tornozelo bimaleolar, trimaleolar, da fratura luxação do tornozelo; e por retirada de placa e/ou parafusos, no período de 2014 a 2019, no município de Belo Horizonte, Minas Gerais. Métodos: estudo retrospectivo descritivo realizado entre 2014 a 2019 com dados epidemiológicos obtidos no banco de dados do Departamento de Informática do Sistema Único de Saúde, oriundos do cadastro da Autorização de Internação Hospitalar e dos valores, total e por serviços hospitalares, despendidos com o tratamento cirúrgico de fratura do tornozelo unimaleolar; o tratamento cirúrgico de fratura do tornozelo bimaleolar, trimaleolar, da fratura de luxação do tornozelo; e o procedimento de retirada de placa e/ou parafusos. Resultados: entre 2014 e 2019 foram registrados 13.721 procedimentos cirúrgicos em região de tornozelo, sendo gastos R$ 7.889.737,75 com as intervenções invasivas. Conclusão: sugere-se a partir dos resultados desta pesquisa a necessidade de reforçar políticas públicas voltadas para a implementação de ações concretas, para à busca de melhor eficácia no processo de seleção de materiais, revisão de protocolos clínicos e cirúrgicos.Palavra-chave: fraturas do tornozelo; fixação interna de fraturas; traumatismos do tornozelo; financiamento da assistência à saúde; ortopedia. Descriptive study on health care financing for surgical treatment of ankle fractures and removal of plates / screws in Belo Horizonte, Minas Gerais, Brazil, 2014-2019 ABSTRACTObjective: to describe hospitalizations and hospital costs for surgical treatment of unimaleolar ankle fractures; by surgical treatment of bimaleolar, trimaleolar ankle fracture, ankle dislocation fracture; and by removing the plate and / or screws, from 2014 to 2019, in the city of Belo Horizonte, Minas Gerais. Methods: retrospective descriptive study carried out between 2014 and 2019 with epidemiological data obtained in the database of the Department of Informatics of the Unified Health System, from the Hospitalization Authorization record and the values, total and for hospital services, spent on treatment surgical fracture of the unimaleolar ankle; surgical treatment of bimaleolar, trimaleolar ankle fracture, ankle dislocation fracture; and the procedure for removing the plate and / or screws. Results: between 2014 and 2019, 13,721 surgical procedures were recorded in the ankle region, with R$ 7,889,737.75 being spent on invasive interventions. Conclusion: it is suggested from the results of this research the need to reinforce public policies aimed at implementing concrete actions, in order to seek better efficiency in the process of selecting materials, reviewing clinical and surgical protocols.Keywords: ankle fractures; internal fracture fixation; ankle injuries; health care financing; orthopedics.

Initial evaluation by a nonsurgeon provider does not delay the surgical care of operative ankle fractures in a walk-in orthopaedic clinic

2019 ◽  
Vol 30 (6) ◽  
pp. 561-565
Author(s):  
Matthew N. Fournier ◽  
Joseph T. Cline ◽  
Adam Seal ◽  
Richard A. Smith ◽  
Thomas W. Throckmorton ◽  
...  
Keyword(s):  
Surgical Care ◽  
Initial Evaluation ◽  
Ankle Fractures ◽  
Orthopaedic Clinic

scholarly journals Evaluation of Results of Extraperiosteal Plating of Pronation-Abduction Ankle Fractures in Adults

2020 ◽  
Vol 19 (2) ◽  
pp. 32-36
Author(s):  
Tafhim Ehsan Kabir ◽  
Salehuddin Ahmad ◽  
Alak Kanti Biswas
Keyword(s):  
Range Of Motion ◽  
Ankle Fracture ◽  
Plantar Flexion ◽  
Deep Infection ◽  
Ankle Fractures ◽  
Foot And Ankle ◽  
Superficial Infection ◽  
Adult Age ◽  
Fibular Fracture ◽  
American Orthopaedic

Background: Pronation-abduction ankle fractures frequently are associated with substantial lateral comminution and is associated with the highest rates of nonunion among indirect ankle fractures. It is one of the common injuries occurring in adult age group where trauma is the main etiology. The present prospective hospital based observational study was conducted to evaluate the functional outcome of treatment of ankle fracture by extraperiosteal plating in a series of patients with pronation-abduction ankle fractures. Materials and methods : A total of 30 consecutive patients aged over 18 years with pronation-abduction ankle fracture were included in the study and underwent surgery by extraperiosteal plating of the fibular fracture. Patients were selected irrespective of sex. The average age of the patients was 36.5 years. Patients with gustilo type III open fractures, pathological fractures were excluded from the study. The patients were evaluated functionally with the use of the American Orthopaedic Foot and Ankle Society score (AOFAS) radiographically, and clinically with range of motion testing. Results: Immediate postoperative and final follow-up radiographs showed that most of the patients had a well-aligned ankle mortise on the fractured side as compared with the normal side on the basis of standardized measurements. All fractures healed without displacement. The average American Orthopaedic Foot and Ankle Society score was 81.5. The range of motion averaged 13° of dorsiflexion and 53° of plantar flexion. Satisfactory results were obtained in 93.33 % patients. Complication includes 2(6.66%) superficial infection, 1(3.33%) deep infection, 4(13.33%) delayed union, 1(3.33%) skin necrosis. Radiological evaluation revealed persistent of talar shift in 1(3.33%) patient postoperatively. Conclusions: Extraperiosteal plating to be an effective method for the stabilization of pronation-abduction ankle fractures. The technique allows for accurate reduction of the mortise without stripping the periosteum of the comminuted region of the fracture. The technique is easier and faster than standard techniques in which the lateral periosteum is split to facilitate placement of the plate. Chatt Maa Shi Hosp Med Coll J; Vol.19 (2); July 2020; Page 32-36

Patients with “benign” Chiari I malformations require surgical decompression at a low rate

2019 ◽  
Vol 23 (4) ◽  
pp. 498-506 ◽  
Author(s):  
Tofey J. Leon ◽  
Elizabeth N. Kuhn ◽  
Anastasia A. Arynchyna ◽  
Burkely P. Smith ◽  
R. Shane Tubbs ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Posterior Fossa ◽  
Multivariate Logistic Regression Analysis ◽  
Large Cohort ◽  
Initial Evaluation ◽  
Published Data ◽  
Posterior Fossa Decompression ◽  
Signal Abnormality ◽  
Chiari I

OBJECTIVEThere are sparse published data on the natural history of “benign” Chiari I malformation (CM-I)—i.e., Chiari with minimal or no symptoms at presentation and no imaging evidence of syrinx, hydrocephalus, or spinal cord signal abnormality. The purpose of this study was to review a large cohort of children with benign CM-I and to determine whether these children become symptomatic and require surgical treatment.METHODSPatients were identified from institutional outpatient records using International Classification of Diseases, 9th Revision, diagnosis codes for CM-I from 1996 to 2016. After review of the medical records, patients were excluded if they 1) did not have a diagnosis of CM-I, 2) were not evaluated by a neurosurgeon, 3) had previously undergone posterior fossa decompression, or 4) had imaging evidence of syringomyelia at their first appointment. To include only patients with benign Chiari (without syrinx or classic Chiari symptoms that could prompt immediate intervention), any patient who underwent decompression within 9 months of initial evaluation was excluded. After a detailed chart review, patients were excluded if they had classical Chiari malformation symptoms at presentation. The authors then determined what changes in the clinical picture prompted surgical treatment. Patients were excluded from the multivariate logistic regression analysis if they had missing data such as race and insurance; however, these patients were included in the overall survival analysis.RESULTSA total of 427 patients were included for analysis with a median follow-up duration of 25.5 months (range 0.17–179.1 months) after initial evaluation. Fifteen patients had surgery at a median time of 21.0 months (range 11.3–139.3 months) after initial evaluation. The most common indications for surgery were tussive headache in 5 (33.3%), syringomyelia in 5 (33.3%), and nontussive headache in 5 (33.3%). Using the Kaplan-Meier method, rate of freedom from posterior fossa decompression was 95.8%, 94.1%, and 93.1% at 3, 5, and 10 years, respectively.CONCLUSIONSAmong a large cohort of patients with benign CM-I, progression of imaging abnormalities or symptoms that warrant surgical treatment is infrequent. Therefore, these patients should be managed conservatively. However, clinical follow-up of such individuals is justified, as there is a low, but nonzero, rate of new symptom or syringomyelia development. Future analyses will determine whether imaging or clinical features present at initial evaluation are associated with progression and future need for treatment.

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