Primary Arthrodesis for Diabetic Ankle Fractures

Background: Treatment of ankle fractures in patients with diabetes is associated with increased complication rates. Ankle arthrodesis is considered a salvage procedure after failed ankle fracture fixation, yet primary ankle arthrodesis has been proposed as a treatment option for patients with significant diabetes-related complications. To date, the characteristics of patients who undergo primary ankle arthrodesis and the associated outcomes have not been described. Methods: A retrospective review was performed of 13 patients with diabetes who underwent primary arthrodesis for traumatic ankle fracture. Patient demographics were characterized in addition to their diabetes complications, Adelaide Fracture in the Diabetic Ankle (AFDA) score, and fracture type. Outcomes assessed included reoperation rates, infection rates, wound complications, nonunion/malunion, amputation, and development of Charcot arthropathy postoperatively. Results: Patients who underwent primary arthrodesis had high rates of diabetes complications, average AFDA scores of 6.4, and high rates of severe injuries, including 38.5% open fractures and 69.2% fracture dislocations. The overall complication rate for primary arthrodesis of ankle fractures in diabetes patients was more than 75% in this cohort. Complications included a 38.5% reoperation rate, 38.5% infection rate, 53.8% wound complication rate, and 23.1% amputation rate. Despite a high nonunion rate at the attempted fusion sites, 89.9% of fractures healed and patients had a stable extremity. Conclusion: This review is the first to characterize the epidemiology and complications of diabetes patients undergoing primary ankle arthrodesis for ankle fractures. In this cohort, patients with multiple diabetic complications and severe injuries underwent primary arthrodesis, which led to an overall high complication rate. Further research is needed to determine the appropriate treatment option for these high-risk patients, and tibiotalocalcaneal stabilization without arthrodesis may be beneficial. Level of Evidence: Level IV, retrospective case series.

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Functional Outcomes After Fracture-Dislocation of the Ankle

Foot & Ankle Specialist ◽

10.1177/1938640019826701 ◽

2019 ◽

Vol 13 (1) ◽

pp. 18-26 ◽

Cited By ~ 1

Author(s):

Direk Tantigate ◽

Gavin Ho ◽

Joshua Kirschenbaum ◽

Henrik C. Bäcker ◽

Benjamin Asherman ◽

...

Keyword(s):

Functional Outcome ◽

Functional Outcomes ◽

Ankle Fracture ◽

Statistical Significance ◽

Ankle Fractures ◽

Fracture Dislocation ◽

Wound Complications ◽

Pain Subscale ◽

Fracture Dislocations

Background. Fracture dislocation of the ankle represents a substantial injury to the bony and soft tissue structures of the ankle. There has been only limited reporting of functional outcome of ankle fracture-dislocations. This study aimed to compare functional outcome after open reduction internal fixation in ankle fractures with and without dislocation. Methods. A retrospective chart review of surgically treated ankle fractures over a 3- year period was performed. Demographic data, type of fracture, operative time and complications were recorded. Of 118 patients eligible for analysis, 33 (28%) sustained a fracture-dislocation. Mean patient age was 46.6 years; 62 patients, who had follow-up of at least 12 months, were analyzed for functional outcome assessed by the Foot and Ankle Outcome Score (FAOS). The median follow-up time was 37 months. Demographic variables and FAOS were compared between ankle fractures with and without dislocation. Results. The average age of patients sustaining fracture-dislocation was greater (53 vs 44 years, P = .017); a greater percentage were female (72.7% vs 51.8%, P = .039) and diabetic (24.2% vs 7.1%, P = .010). Wound complications were similar between both groups. FAOS was generally poorer in the fracture-dislocation group, although only the pain subscale demonstrated statistical significance (76 vs 92, P = .012). Conclusion. Ankle fracture-dislocation occurred more frequently in patients who were older, female, and diabetic. At a median of just > 3-year follow-up, functional outcomes in fracture-dislocations were generally poorer; the pain subscale of FAOS was worse in a statistically significant fashion. Levels of Evidence: Therapeutic, Level III

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

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00187 ◽

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.

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Risk Stratification for Ankle Fracture Complications in Diabetic Patients

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00255 ◽

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.

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Safety and Outcomes of Early Fixation in Patients who Suffered an Ankle Fracture

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00433 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0043

Author(s):

Ashish Shah ◽

Jacob Hawkins ◽

Bradley Alexander ◽

Abhinav Agarwal ◽

Benjamin B. Cage ◽

...

Keyword(s):

Fracture Fixation ◽

Ankle Fracture ◽

Wound Complication ◽

The United States ◽

Ankle Fractures ◽

Wound Complications ◽

Time To Surgery ◽

Prolonged Immobilization ◽

Early Fixation ◽

Injury Classification

Category: Ankle Introduction/Purpose: Ankle fractures are a common injury in the United States leading to increased ER visits and healthcare costs. Additionally, these injuries normally lead to prolonged immobilization that can make it difficult for patients to return to work and normal activities. By optimizing fracture healing and decreasing the amount of time to union patients can avoid the frustration of prolonged immobilization and return to daily activities more quickly. It is believed that early surgical fixation of ankle fractures can lead to wound complications while late fixation can lead to issues with reduction during surgical intervention. This study was undertaken to determine if there is a difference in wound complication and time to union between early and late fracture fixation. Methods: From July of 2008 to June of 2018, a retrospective chart review of 321 patients who underwent ankle fracture corrected with ORIF was performed at a single institution. Patients with pilon fractures, poly trauma, open fractures, or less than 3 months of follow up time were excluded from our study. After exclusion were made there was 232 patients remaining. All patients were then stratified by time to surgery after injury and injury classification. The cohorts were surgery within 2 days with 31 patients, surgery within 7 days with 69 patients, and patients that had surgery after 8 days (132). The patients were also stratified according to the Lauge-Hansen classification. The cohorts were PA, PER, SA, and SER. Results: The average time to union for patients who were operated on within 2 days of injury was 108.48 days, 106.52 days for patients operated on between 3-7 days, and 97.59 days for patients operated on after 7 days. Wound complications were highest in the cohort operated on within 2 days at 9.6%. Patients operated on between 3 and 7 days had the lowest rate of wound complications at 2.8%/. Patients with an SER Lauge-Hansen classification has the fastest time to union at 94.04 days and individuals with an SA had the longest at 139.30 days. Wound frequency for patients with a classification of PA had the highest wound complications at 20%. Conclusion: There has been little research done on how time to surgery affects wound complications and healing time in ankle fracture fixation. Patients that received surgery after 7 days achieved union the fastest. We saw that wound complication rate was greatest in the cohort that had surgery within 2 days of injury. Injury classification did factor into union time and wound complications. Overall, there was not a significant difference in wound complication between early fixation and delayed fixation. [Table: see text]

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Preoperative Ankle Swelling and the Effect on Postoperative Wound Complications Following Ankle Fracture Surgery

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00113 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0011

Author(s):

Anthony Silva ◽

Simon Platt

Keyword(s):

Soft Tissue ◽

Ankle Fracture ◽

Operative Time ◽

Operative Intervention ◽

Ankle Fractures ◽

Wound Complications ◽

Soft Tissue Management ◽

Time To Surgery ◽

Soft Tissue Problems ◽

Fracture Surgery

Category: Trauma Introduction/Purpose: It is widely perceived that swelling in the first 24-48 hours following an ankle fracture precludes fixation, delaying operative treatment by 10-14 days to allow swelling to reduce. Such soft tissue management is assumed to be associated with better immediate soft tissue outcomes (wound closure) and mitigation of medium to long-term soft tissue problems. The aim of this study is to identify whether pre-operative ankle swelling has an independent effect on post-operative wound complications following ankle fracture surgery. The hypothesis of this study is that operative intervention at any point in time after the fracture of the ankle, irrespective of swelling, will show no better or worse soft tissue outcomes than those fixations delayed for swelling. The primary outcome measure will be wound complication. Methods: This is a prospective cohort study of patients presenting to a tertiary referral centre that were operatively managed for malleolar ankle fractures. Skeletally mature patients with closed, isolated ankle fractures were included in the study. Patients who were multiply-injured, had open fractures, and/or had known pre-existing limb oedema were excluded. Time to surgery was determined by the on-call attending orthopaedic surgeon. Ankle swelling of both the operative and non-operative limb was measured using the validated ‘Figure-of-eight’ measurement around the foot and ankle to quantify swelling of the affected ankle. A ratio of the patient’s 2 ankles was used as the measure of swelling to eliminate any bias between operators and standardise measurements between patients. Visual assessment of swelling was also recorded. Follow up was at 2, 6, and 12 weeks. Wound complications, patient co-morbidities, operative time, surgeon experience, and hospital stay duration were recorded Results: A total of 50 patients met inclusion criteria. Demographics were a 69% female predominance, a mean age of 45, and age range of 17- 69 years. A complication rate of 4% (n=2) was identified with both complications being superficial wound infections requiring oral antibiotics and wound episodes for treatment. Time to surgery had a mean of 6 days (range 0- 20). There was no significant difference in ankle swelling or time to surgery between patients with wound complications and those without. There were no significant differences identified between these groups when considering BMI, smoking status, diabetes, or peripheral vascular disease. Level of operating surgeon, operative time, tourniquet time, and closure material were also not significantly different between patients with and without wound complications. Conclusion: Our results show little post-operative soft tissue complications. If anything, our results are consistent with or show fewer soft tissue problems than the reported literature, despite a range of time to intervention. While we acknowledge that there may be a bias between surgeons in their preference in soft tissue management; we perceive that our study was sufficiently pragmatic to level this effect. Pre-operative swelling and time to operative intervention in ankle fracture surgery were not shown to correlate with change in soft tissue outcomes following ankle fracture surgery.

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Hemoglobin A1c and preoperative glycemia as a decision tool to help minimise sternal wound complications: a retrospective study in OPCAB patients

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01580-1 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Jef Van den Eynde ◽

Abel Van Vlasselaer ◽

Annoushka Laenen ◽

Delphine Szecel ◽

Bart Meuris ◽

...

Keyword(s):

Retrospective Study ◽

Hemoglobin A1c ◽

Clinical Decision Making ◽

Artery Bypass ◽

Clinical Decision ◽

Wound Complications ◽

Minimal Risk ◽

Off Pump ◽

Increased Risk ◽

Diabetes Patients

Abstract Background Poor glycemic control has been associated with an increased risk of wound complications after various types of operations. However, it remains unclear how hemoglobin A1c (HbA1c) and preoperative glycemia can be used in clinical decision-making to prevent sternal wound complications (SWC) following off-pump coronary artery bypass grafting (OPCAB). Methods We conducted a retrospective study of 1774 consecutive patients who underwent OPCAB surgery between January 2010 and November 2016. A new four-grade classification for SWC was used. The associations of HbA1c and preoperative glycemia with incidence and grade of SWC were analysed using logistic regression analysis and proportional odds models, respectively. Results During a median follow-up of 326 days (interquartile range (IQR) 21–1261 days), SWC occurred in 133/1316 (10%) of non-diabetes and 82/458 (18%) of diabetes patients (p < 0.001). Higher HbA1c was significantly associated with a higher incidence of SWC (odds ratio, OR 1.24 per 1% increase, 95% confidence interval, CI 1.04;1.48, p = 0.016) as well as a higher grade of SWC (OR 1.25, 95% CI 1.06;1.48, p = 0.010). There was no association between glycemia and incidence (p = 0.539) nor grade (p = 0.607) of SWC. Significant modifiers of these effects were found: HbA1c was associated with SWC in diabetes patients younger than 70 years (OR 1.41, 95% CI 1.17;1.71, p < 0.001), whereas it was not in those older than 70 years. Glycemia was associated with SWC in patients who underwent non-urgent surgery (OR 2.48, 95% CI 1.26;4.88, p = 0.009), in diabetes patients who received skeletonised grafts (OR 4.83, 95% CI 1.28;18.17, p = 0.020), and in diabetes patients with a BMI < 30 (OR 2.19, 95% CI 1.01;4.76, p = 0.047), whereas it was not in the counterparts of these groups. Conclusions Under certain conditions, HbA1c and glycemia are associated SWC following OPCAB. These findings are helpful in planning the procedure with minimal risk of SWC.

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

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00408 ◽

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.

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Principles and guidelines in the management of ankle fractures in adults

Journal of Perioperative Practice ◽

10.1177/1750458920969029 ◽

2021 ◽

pp. 175045892096902

Author(s):

Harry Kyriacou ◽

Ahmed MHAM Mostafa ◽

Benjamin M Davies ◽

Wasim S Khan

Keyword(s):

Clinical Guidelines ◽

Ankle Fracture ◽

Ankle Fractures ◽

Recent Developments ◽

Psychosocial Complications ◽

British Orthopaedic Association

Ankle fractures are common injuries that have many physical and psychosocial complications. As a result, it is important to be aware of how these patients present and are managed perioperatively. Detailed guidelines from NICE and the British Orthopaedic Association have been produced on this topic, including recent developments such as the decision to weight-bear early after surgery and the use of virtual fracture clinics. This article provides an overview of the key perioperative factors that need to be considered in cases of ankle fracture and the relevant clinical guidelines.

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

Trials ◽

10.1186/s13063-021-05319-0 ◽

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.

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

Foot & Ankle International ◽

10.1177/10711007211002811 ◽

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

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