scholarly journals Complications Associated with Lisfranc Injury Open Reduction Internal Fixation versus Primary Arthrodesis: A Matched Cohort Study

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0039
Author(s):  
William V. Probasco ◽  
Benjamin E. Stein ◽  
Cyrus Fassihi ◽  
Nazia Hossain
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Perioperative Complications ◽  
Financial Burden ◽  
Length Of Hospital Stay ◽  
Cost Of Care ◽  
Wound Complications ◽  
Prior History ◽  
Inpatient Setting ◽  
Hardware Failure

Category: Trauma; Midfoot/Forefoot Introduction/Purpose: Lisfranc injuries are complex injuries of the midfoot in which the optimal course of treatment remains controversial. The objective of this study was to identify whether open reduction and internal fixation (ORIF) was associated with greater risk for surgical complications and/or greater financial burden in comparison to a primary arthrodesis (PA). Methods: A retrospective database review was conducted using the PearlDiver database to identify all Medicare patients who underwent a Lisfranc ORIF or PA in an inpatient setting from 2006-2013. Exclusion criteria included age >85 years and a prior history of foot or ankle trauma/infection/malignancy within 5 years of index surgery. Patients were matched in a 1:1 statistical manner to precisely control for potential influence of comorbidities and demographics, resulting in two cohorts with 2746 patients in each. Perioperative complications (within 30 days) were compared between the cohorts, in addition to the respective costs associated with each procedure. Complications were broken down into major (PE/DVT, MI, CVA, sepsis, mortality, nerve injury) or minor (UTI, PNA, hardware failure, transfusion, wound complications) categories. Results: No significant differences in major perioperative complications were noted between the two procedures. Significant differences were however noted in the incidence of minor perioperative complications, including higher rates of hardware failure (OR 0.26 (CI 95%, 0.07-0.752, P=0.021) and transfusion (OR 0.37 (CI 95%, 0.13-0.94, P=0.045) in the ORIF cohort. There was additionally a higher incidence of 30 day readmission (OR 0.35 (CI 95%, 0.24-0.51, P<0.001) with ORIF. Length of hospital stay (LOS) was shorter in the PA cohort (x̅; = 2.59 days) compared to the ORIF cohort (x̅; = 5.58 days, p < 0.001). Higher mean total hospital costs were noted for ORIF (x̅ = $66,342.56) compared to PA (x̅ = $40,761.65, p < 0.001). Conclusion: Within our study population, ORIF has a significantly higher rate of hardware failure and transfusion, and 2.5 times the risk of readmission within 30 days. When comparing the total cost of care, there was a significantly greater cost with ORIF. LOS was also significantly longer in the ORIF group. One weakness of this study was the ability to account for patients <65, as these were pooled into a single age group by the database. While revealing with regard to the aforementioned variables, further research still needs to be conducted on the functional outcomes of these procedures. [Table: see text][Table: see text][Table: see text]

scholarly journals Complications Associated with Triple Arthrodesis Versus Non-Fusion Flatfoot Reconstruction: A Matched Cohort Study

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0039
Author(s):  
William V. Probasco ◽  
Benjamin E. Stein ◽  
Cyrus Fassihi ◽  
Lea McDaniel
Keyword(s):  
Postoperative Complication ◽  
Multivariate Regression ◽  
Financial Burden ◽  
Cost Of Care ◽  
Wound Complications ◽  
Complication Rates ◽  
Triple Arthrodesis ◽  
Total Cost ◽  
Significant Difference ◽  
Reconstruction Group

Category: Hindfoot; Midfoot/Forefoot; Other Introduction/Purpose: Pes planovalgus is a very common deformity of the foot, often resulting from adult acquired flatfoot disorder (AAFD). This deformity in its early stages is treated conservatively with non-operatively modalities such as bracing, however in its later stages often requires surgical correction of the deformity in order to improve the pain and function of the extremity. Two commonly performed procedures in the correction of this type of deformity are a triple arthrodesis or joint sparing flatfoot reconstruction. The objective of this study was to identify whether differences existed in the financial burden or complication rates of non-fusion flatfoot reconstruction versus triple arthrodesis. Methods: The PearlDiver Database was queried from 2006-2013 to identify all Medicare patients who were admitted for a triple arthrodesis or non-fusion flatfoot reconstruction. 2308 patients were identified in each cohort and statistically matched in a 1:1 manner to control for influence of demographics and/or comorbidities. Postoperative complication rates (within 30 days) were evaluated and broken down into major (PE/DVT, MI, CVA, sepsis, mortality, nerve injury) and minor (UTI, PNA, hardware failure, transfusion, wound complications) categories. Additionally, total cost of care including cost of readmissions, and readmission within 30 days were evaluated. Results: No significant differences were noted in the postoperative complication rates between the two procedures within the first 30 days post-operatively in the initial univariate regression. There was a significant difference in the rate of 30 day readmission with 2.3% of triple arthrodeses being readmitted vs. 1.08% in the non-fusion joint reconstruction group (p=.002). Adjusted multivariate regression yielded similar results, with no significant differences in postoperative complication rates. The difference in readmission rate remained significant in the multivariate regression (OR 2.13, 95% CI 1.33-3.51, p=.002). Significant differences were also noted for mean total cost of care, with a higher mean total cost identified for the fusion group (x=7,868.0) compared to the reconstruction group (x=4,064.49, p<.001, Adjusted 𝛽𝛽 3,836.71, 95% CI 3,525.23 to 4,148.19, p<.001). Conclusion: This study compared triple arthrodesis versus joint-sparing flatfoot reconstruction. Within this study group there was no difference in complications between the two procedures. There was a significantly higher incidence of 30-day readmission in the triple arthrodesis group by about 2-fold. When comparing the total cost of care, there was a significantly higher cost associated with the triple arthrodesis, which cost on average about $3800 more than joint sparing flatfoot reconstruction. While revealing with regard to the aforementioned variables within the first 30 days post-operatively, further research needs to be conducted on the long term outcomes of these procedures. [Table: see text][Table: see text][Table: see text]

scholarly journals Wound complications after open reduction and internal fixation of tibial plateau fractures in the elderly: a multicentre study

2018 ◽  
Vol 43 (2) ◽  
pp. 461-465 ◽  
Author(s):  
Christopher L. Gaunder ◽  
Zibin Zhao ◽  
Corey Henderson ◽  
Brandon R. McKinney ◽  
Philip F. Stahel ◽  
...  
Keyword(s):  
Multicentre Study ◽  
Internal Fixation ◽  
Open Reduction ◽  
Tibial Plateau ◽  
The Elderly ◽  
Tibial Plateau Fractures ◽  
Wound Complications

Orthogonal Plating of Vancouver B1 and C-Type Periprosthetic Femur Fracture Nonunions

2017 ◽  
Vol 27 (6) ◽  
pp. 578-583 ◽  
Author(s):  
Christopher E. Birch ◽  
Michael Blankstein ◽  
Jesse D. Chlebeck ◽  
Craig S. Bartlett 3rd
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Femur Fracture ◽  
Plate Osteosynthesis ◽  
Perioperative Complications ◽  
Femoral Shaft ◽  
Open Reduction Internal Fixation ◽  
Fixation Method ◽  
Periprosthetic Femur Fracture ◽  
Fracture Nonunions

Background Periprosthetic femoral shaft fractures are a significant complication after total hip arthroplasty (THA). Plate osteosynthesis has been the mainstay of treatment around well-fixed stems. Nonunions are a rare and challenging complication of this fixation method. We report the outcomes of a novel orthogonal plating surgical technique for Vancouver B1 and C-type periprosthetic fractures that previously failed open reduction internal fixation (ORIF). Methods A retrospective review identified all patients with Vancouver B1/C THA periprosthetic femoral nonunions from 2010 to 2015. Exclusion criteria included open fractures and periprosthetic infections. The technique utilised a mechanobiologic strategy of atraumatic exposure, resection of necrotic tissue, bone grafting with adjuvant bone morphogenetic protein (BMP) and revision open reduction internal fixation with orthogonal plate osteosynthesis. Results 6 Vancouver B1/C periprosthetic femoral nonunions were treated. 5 patients were female with an average age of 80.3 years (range 72-91 years). The fractures occurred at a mean of 5.8 years (range 1-10 years) from their initial arthroplasty procedure. No patients underwent further revision surgery; there were no perioperative complications. All patients had a minimum of 11 months follow-up (mean 18.6, range 11-36 months). All fractures achieved osseous union, defined as solid bridging callus over at least 2 cortices and pain free, independent ambulation, at an average of 24.4 weeks (range 6.1-39.7 weeks). Conclusions This is the 1st series describing orthogonal locked compression plating using modern implants for periprosthetic femoral nonunions. This technique should be considered in periprosthetic femur fracture nonunions around a well-fixed stem.

scholarly journals Comparison of open reduction and internal fixation versus closed reduction and percutaneous fixation for medial malleolus fractures

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002
Author(s):  
Andrew Matson ◽  
Stephen Barchick ◽  
Samuel Adams
Keyword(s):  
Internal Fixation ◽  
External Fixation ◽  
Closed Reduction ◽  
Open Reduction ◽  
Wound Complications ◽  
Complication Rates ◽  
Percutaneous Fixation ◽  
Open Injury ◽  
Increased Risk ◽  
Significant Difference

Category: Ankle, Trauma Introduction/Purpose: Open approaches are often used for the operative treatment of medial malleolar (MM) fractures. Compared to percutaneous approaches, open approaches may entail an increased risk of operative morbidity, postoperative pain, wound complications, and reoperation for hardware removal. However, inherent to minimally invasive or percutaneous techniques is incomplete fracture visualizationwhich may hinder acceptable reduction. In this study, we aimed to compare patients treated with closed reduction and percutaneous fixation (CRPF) to those patients treated with traditional open reduction and internal fixation (ORIF). We hypothesized that the two groups would be similar with regard to patient factors, injury variables, and outcomes. Methods: The study group consisted of 184 consecutive patients who met inclusion criteria and were treated with operative fixation of a MM fracture from 2011-2015 at a single institution. Forty underwent CRPF and 144 underwent ORIF. Patient demographics, injury characteristics, treatment methods, and outcome variables were recorded through review of patient charts, radiographs, and operative reports. Results: Patient variables were similar between groups except for years of age, which was greater on average in the CRPF group (55 vs. 48, p = 0.03). The CRPF treatment group had a higher rate of initial open injury (22% vs. 7%, p<0.01), a lower rate of MM fracture comminution (12% vs. 29%, p = 0.03), and a higher rate of provisional external fixation (35% vs. 14%, p<0.01). There was no statistically significant difference observed between the CRPF and ORIF groups with regard to outcomes including: nonunion (2% vs. 3%), malunion (10% vs. 5%), time to union (10 weeks, each), removal of hardware (8% vs. 14%), or wound complications (0% vs. 4%). Conclusion: Both CRPF and ORIF resulted in acceptable radiographic outcomes and low complication rates for the treatment of MM fractures. Compared to the ORIF group, patients in the CRPF group on average were older and more often had comminution, open fractures, and provisional external fixation.

Effect of Early Weightbearing Following Open Reduction and Internal Fixation of Unstable Ankle Fractures on Wound Complications or Failures of Fixation

2019 ◽  
Vol 40 (12) ◽  
pp. 1397-1402 ◽  
Author(s):  
Casey Pyle ◽  
Michael Kim-Orden ◽  
Tyler Hughes ◽  
Brian Schneiderman ◽  
Robert Kay ◽  
...  
Keyword(s):  
Cohort Study ◽  
Internal Fixation ◽  
Retrospective Cohort Study ◽  
Open Reduction ◽  
Retrospective Cohort ◽  
Ankle Fractures ◽  
Wound Complications ◽  
Fracture Union ◽  
Wound Breakdown ◽  
Hardware Failures

Background: There is a growing trend toward early weightbearing as tolerated (WBAT) after open reduction and internal fixation (ORIF) of ankle fractures. To date, studies have excluded fractures with associated syndesmotic injuries from their cohorts. Methods: In this retrospective cohort study, a chart review was performed at a single level 1 trauma center, identifying all unstable ankle fractures that underwent operative fixation between July 2016 and July 2017. After exclusion criteria, 63 patients were identified and 31 were included in the final analysis, with 14 undergoing syndesmotic fixation. WBAT was initiated after suture removal, between 2 and 4 weeks postoperatively. Outcomes included fracture union, radiographic maintenance of alignment, hardware failures, wound complications, and the need for repeat surgery. Results: Weightbearing was initiated at an average of 17.8 days. All 31 patients progressed toward fracture union, with no hardware failures. Three patients developed superficial wound breakdown, which was treated with protected weightbearing in all cases and oral antibiotics in 1 case. All 3 went on to heal from their incisions. One patient had delayed wound breakdown and required a split-thickness skin graft that subsequently healed without complication. One patient underwent hardware removal 6 months postoperatively. There were no revision ORIF procedures. Conclusion: There is literature supporting early WBAT after ORIF of unstable ankle fractures in patients without major comorbidities. This article supports this trend, demonstrating that a group of ankle fractures requiring syndesmotic fixation were included in the early weightbearing cohort without a higher rate of catastrophic failure or increased wound problems. Level of Evidence Level IV, retrospective cohort study.

scholarly journals Cost Comparison and Complication Rate of Lisfranc Injuries Treated with Open Reduction Internal Fixation versus Primary Arthrodesis

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0012
Author(s):  
Brandon Barnds ◽  
William Tucker ◽  
Brandon L. Morris ◽  
John Paul Schroeppel ◽  
Scott M. Mullen ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Complication Rate ◽  
Average Cost ◽  
Open Reduction ◽  
Open Reduction Internal Fixation ◽  
Cost Of Care ◽  
Hardware Removal ◽  
Lisfranc Injury ◽  
Hardware Complications ◽  
Lisfranc Injuries

Objectives: Controversy exists regarding optimal primary management of Lisfranc injuries. Whether open reduction internal fixation or primary arthrodesis is superior remains unknown. Our retrospective study uses a private payer database to compare cost, complication rate, and hardware removal rate in Lisfranc injuries treated with primary open reduction internal fixation or primary arthrodesis. Methods: Utilizing data mining software created by a private organization, a national insurance database of approximately 23.5 million orthopedic patients was retrospectively queried for subjects who were diagnosed with a Lisfranc injury from 2007-2016 based on international classification of diseases (ICD) codes for tarsometatarsal (TMT) dislocation (PearlDiver, Colorado Springs, CO). Patients with TMT dislocations then progressed on to either non-operative treatment, open reduction internal fixation, or primary arthrodesis. Associated treatment costs based on diagnosis codes were followed after initial diagnosis and t-tests were used to determine statistical significance. Subgroups were then created based on having at least one complication ICD or current procedural terminology (CPT) code after the beginning of treatment, which included: hemorrhage, infection, nonunion, malunion, thromboembolism, wound and hardware complications, or amputation. Additionally, patients undergoing implant removal were identified by CPT code for removal of hardware performed after the index procedure. Complication and hardware removal rates were compared with chi-square test. Results: 2205 subjects with a diagnosis of Lisfranc injury were identified in the database. 1248 patients underwent non-operative management, 670 underwent open reduction internal fixation, and 212 underwent primary arthrodesis. The average cost of care associated with primary arthrodesis was greater ($5,005.82) than for open reduction internal fixation ($3,961.97, P=0.045). The overall complication rate was 23.1% (155/670) for open reduction internal fixation and 30.2% (64/212) for primary arthrodesis ( P=0.04). Rates of hardware removal independent of complications were 43.6% (292/670) for open reduction internal fixation and 18.4% (39/212) for arthrodesis ( P<0.001). Furthermore, 2.5% (17/670) patients in the open reduction internal fixation group progressed to arthrodesis at a mean of 308 days, average cost of care associated with this group of patients was $9,505.12. Conclusion: Primary arthrodesis for the management of acute Lisfranc injuries is both significantly more expensive and has a higher complication rate than open reduction internal fixation. Open reduction internal fixation demonstrated a low rate of progression to arthrodesis, although there was a high rate of hardware removal, which may represent a planned second procedure in the management of a substantial number of patients treated with open reduction internal fixation.

scholarly journals Treatment of Mandibular Angle Fractures with Single Three-Dimensional Locking Miniplates without Maxillomandibular Fixation: How Much Fixation is Required?

2017 ◽  
Vol 10 (3) ◽  
pp. 188-196 ◽  
Author(s):  
Sanjay Rastogi ◽  
Sam Paul ◽  
Sumedha Kukreja ◽  
Karun Aggarwal ◽  
Rupshikha Choudhury ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Three Dimensional ◽  
Mouth Opening ◽  
Mandibular Angle ◽  
Analog Scale ◽  
Hardware Failure ◽  
Angle Fractures ◽  
Fracture Stability

The aim of this simple nonrandomized and observational study was to evaluate the efficacy of single three-dimensional (3D) plate for the treatment of mandibular angle fractures without maxillomandibular fixation. A total of 30 patients with noncomminuted fractures of mandibular angle requiring open reduction and internal fixation were included in the study. All the patients were treated by open reduction and internal fixation using single 3D titanium locking miniplate placed with the help of transbuccal trocar or Synthes 90-degree hand piece and screw driver. 3D locking titanium miniplates used in our study was four-holed, box-shaped plate, and screws with 2 mm diameter and 8 mm length. The following clinical parameters were assessed for each patient at each follow-up visit: pain (visual analog scale: 0–5), swelling (visual analog scale: 0–5), mouth opening, infection, paresthesia, hardware failure (plate fracture), occlusal discrepancies, and mobility between fracture fragments. A significant decrease in pain level was seen during the follow-up visits. No statistically significant changes were seen in swelling, but mouth opening increased in the subsequent visits. Also better results were seen in terms of fracture stability and occlusion in the postoperative period. Two cases of infection and two cases of hardware failure were noted in sixth postoperative week. 3D plating system is an easy to use alternative to conventional miniplates to treat mandibular angle fractures that uses lesser foreign material, thus reducing the operative time and overall cost of the treatment. Better fracture stability and occlusion was also achieved using the 3D plating system.

scholarly journals Paratricepital approach for open reduction and internal fixation of delayed presentation of pediatric supracondylar humerus fracture

2019 ◽  
Vol 6 (1) ◽  
pp. 107
Author(s):  
Ramachandra Subbasetty ◽  
Dayanand Manjunath ◽  
Deepak Shivanna ◽  
Narasimha Murthy
Keyword(s):  
Internal Fixation ◽  
Functional Outcome ◽  
Open Reduction ◽  
Perioperative Complications ◽  
Humerus Fracture ◽  
Delayed Presentation ◽  
Supracondylar Humerus Fracture ◽  
Fractures In Children ◽  
The Mean

<p class="abstract"><strong>Background:</strong> Delayed presentation of pediatric displaced supracondylar humerus fracture is relatively common. Management of such cases have higher incidence of perioperative complications and usually require open reduction and pinning. Open reduction can be done by various approaches, each having its own advantage and disadvantages.</p><p class="abstract"><strong>Methods:</strong> A prospective study was done comprising 20 children with displaced Supracondylar fracture presented 2-14 days of injury, Mean patient age was 6 years. 15 were boys and 5 were girls. Children in whom closed reduction and percutaneous pinning was achieved, vascular injury and more than 2 weeks old fracture cases were excluded. Paratricepital approach was used for Open reduction and pinning for all the cases. The functional outcome was assessed using Flynn criteria.<strong></strong></p><p class="abstract"><strong>Results:</strong> In all cases the fracture had united at complete follow-up and the mean follow-up period was 16 months. The outcome was excellent in 15 (75%), good in 3 (15%), fair in 1 (5%), and poor in 1 (5%) patients. The mean Baumann angle was 76º in the affected elbow and 73º in the normal elbow. Average time for complete union in the current study was 7 weeks. Pin tract infection was seen in 2, stiffness in 2 patients, cubitus varus in 1 patient. No case of compartment syndrome or iatrogenic nerve injury was seen was recorded.</p><p class="abstract"><strong>Conclusions:</strong> Finally, we concluded that triceps sparing paratricepital approach is an easy, simple and safe approach for exposure and internal fixation of supracondylar humeral fractures in children with excellent functional outcome.</p>

scholarly journals Treatment of Periprosthetic Femoral Fractures Vancouver Type B2: Revision Arthroplasty Versus Open Reduction and Internal Fixation With Locking Compression Plate

2019 ◽  
Vol 10 ◽  
pp. 215145931987685 ◽  
Author(s):  
C. Baum ◽  
M. Leimbacher ◽  
P. Kriechling ◽  
A. Platz ◽  
D. Cadosch
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Operating Time ◽  
Group Versus ◽  
Revision Arthroplasty ◽  
Femoral Fractures ◽  
Length Of Hospital Stay ◽  
Invasive Procedure ◽  
Less Invasive ◽  
Revision Operations

Introduction: The Vancouver algorithm recommends revision arthroplasty (RA) for Vancouver type B2 (VTB2) fractures. However, open reduction and internal fixation (ORIF) using locking compression plates (LCP) may be a valid and less invasive alternative treatment. Materials and Methods: Between January 2007 and March 2017, we retrospectively recruited all patients treated with either ORIF with LCP or RA for VTB2 fractures in our clinic. All of the following were reviewed: the length of hospital stay, the operating time, the need for blood transfusions during and/or after surgery, implant-related and patient-related complications, need for revision surgery, and the radiological outcome. Additionally, the functional outcome was investigated. Results: Fifty-nine patients were recruited. Thirty-five (59.3%) patients underwent RA, while 24 (40.7%) patients received ORIF with LCP. The median surgical time was 137.50 minutes in the LCP group compared to 160.00 minutes in the RA group ( P = .051). Three (12.5%) patients in the LCP group and 10 (28.6%) patients in the RA group experienced an implant-associated complication ( P = .131). Patient-related complications occurred in 3 (12.5%) patients in the LCP group versus 6 (17.1%) patients in the RA group ( P = .628). The mean preoperative Parker mobility score was 9 points in both groups and decreased in both groups to a mean of 5 points in the LCP and 7 points in the RA group. Discussion: Open reduction and internal fixation with LCP seems to be a less invasive procedure for VTB2 fractures in comparison to RA. It is a bone-sparing procedure that can be advantageous for further revision operations. Moreover, some fractures can only be anatomically reduced by ORIF with LCP, whereas for proximal fractures with a radiologically unambiguously loosened stem RA might be advantageous. Conclusion: In line with previously published studies, our data suggest that ORIF using LCP is a valid treatment option for VTB2 fractures.

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