scholarly journals Operative Fixation of Ankle Fractures: The Effect of Time to Surgery on Length of Stay and Soft Tissue Complication Rates

2014 ◽  
Vol 04 (03) ◽  
Author(s):  
Yasmine Kamhieh ◽  
Dimitra Leivadiotou ◽  
Dimitrios Manoukian
Keyword(s):  
Soft Tissue ◽  
Length Of Stay ◽  
Ankle Fractures ◽  
Complication Rates ◽  
Time To Surgery ◽  
Soft Tissue Complication ◽  
Operative Fixation

scholarly journals Ankle Fracture Complications in the Elderly

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0038
Author(s):  
Andrew Polk ◽  
Brian Buck ◽  
Michael Robertson ◽  
James Cook ◽  
Courtney Felton
Keyword(s):  
Geriatric Patient ◽  
Patient Population ◽  
Age Groups ◽  
Adverse Outcomes ◽  
Ankle Fractures ◽  
Complication Rates ◽  
Geriatric Population ◽  
Fracture Dislocations ◽  
Operative Fixation ◽  
Time From Injury

Category: Trauma Introduction/Purpose: In the geriatric patient population, pre-existing medical conditions and poor bone quality often make operative fixation of unstable ankle fractures and fracture-dislocations more challenging. The objective of this study was to characterize the complications that occurred following operative fixation of these injuries at our institution and to determine whether complication rates were higher in our geriatric patient population (65 years and older) as compared to our younger patient population. We hypothesized that complication rates in the geriatric population would be significantly higher relative to complication rates in the younger population. We also hypothesized that in elderly patients, the soft tissue envelope would be less forgiving and require significantly more time for swelling to decrease to a level considered appropriate for definitive surgical fixation to occur. Methods: With IRB approval, a review of medical records for patients diagnosed with ankle fractures or fracture-dislocations and operated on between January of 2015 and December of 2016 was performed. Major complications were defined as any adverse outcomes requiring further surgical intervention such as irrigation and debridement for infection or exposed hardware, nonunion, major hardware failure, or amputation. Minor complications included other adverse outcomes which did not require further surgical intervention such as wound dehiscence, loss of reduction, or delayed union. Data were compared for statistically significant (p<0.05) differences. Results: Medical record review produced 110 patients meeting criteria for inclusion with a mean follow-up of 179 days (range, 0 to 601 days). No significant (p>0.08) differences were noted in rates of major, minor, or total complications between geriatric and younger patients treated at our institution (Fig. 1). An analysis of patient characteristics, demonstrated a significantly (p=0.035) higher proportion of trimalleolar ankle fractures within the geriatric population, but the proportions of other injury types were not significantly (p>0.198) different between age groups. Prevalence of tobacco use, alcohol use, illicit drug use, or diabetes mellitus was not found to be significantly different (p>0.058) between age groups. No significant (p=0.12) difference was found in time from injury to definitive surgical treatment between age groups. Conclusion: Complication rates following operative treatment of ankle fractures and fracture-dislocations were not significantly higher in our geriatric patient population, although the incidence of minor complications in the geriatric population was markedly increased relative to the younger population. A lack of significant difference in time from injury to definitive surgical treatment between age groups suggests that geriatric patients may not require a prolonged time for soft tissue swelling to decrease prior to surgery. Further study with a larger sample size is needed to determine if these findings are clinically significant.

Influence of Time to Surgery in Ankle Fractures on the Rate of Complications and Length of Stay – a Multivariate Analysis

2018 ◽  
Vol 157 (02) ◽  
pp. 183-187
Author(s):  
Rene Burchard ◽  
Karacan Hamidy ◽  
Anke Pahlkötter ◽  
Christian Soost ◽  
Michael Palm ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Length Of Stay ◽  
Ankle Fractures ◽  
Time To Surgery

Zusammenfassung Hintergrund Mit einer Inzidenz von 9/1000 pro Jahr ist die Malleolarfraktur des oberen Sprunggelenkes eine der häufigsten Frakturen des menschlichen Skeletts. Häufig stellt sich die Frage, ob der Zeitpunkt einer operativen Maßnahme Einfluss auf die Komplikationsrate oder die Krankenhausverweildauer ausübt oder ob andere Patientencharakteristika oder Komorbiditäten darauf Einfluss nehmen. Material und Methoden Aufgrund der bisher sehr heterogenen Datenlage im Hinblick auf den optimalen Operationszeitpunkt bei Malleolarfrakturen erfolgte in der vorliegenden Arbeit eine multivariate Regressionsanalyse im Rahmen einer retrospektiven Kohortenstudie (n = 421). Ergebnisse In der multivariaten Regressionsanalyse zeigten sich keine Vorteile einer primären operativen Versorgung innerhalb von 6 Stunden gegenüber der sekundären Therapie nach ca. 1 Woche im Hinblick auf die lokale postoperative Komplikationsrate oder die Krankenhausverweildauer. Ein höheres Patientenalter bzw. ein begleitender Weichteilschaden höheren Grades waren mit einer verlängerten Krankenhausverweildauer assoziiert. Schlussfolgerung Diese aktuelle Auswertung eines 5-Jahres-Zeitraums zeigt, dass die Wahrscheinlichkeit des Auftretens einer schwerwiegenden lokalen Komplikation nach operativer Versorgung einer Malleolarfraktur weder vom OP-Zeitpunkt noch von weiteren Kovariablen wie dem Alter oder von Komorbiditäten des Patienten beeinflusst wird. Die Empfehlung der primären Versorgung innerhalb von 6 – 8 Stunden entsprechend der aktuellen S2-Leitlinie „Sprunggelenkfraktur“ sollte nach den Ergebnissen der vorliegenden Studie in einer prospektiv randomisierten Untersuchung reevaluiert werden.

scholarly journals Cost Benefit with Early Operative Fixation of Unstable Ankle Fractures

2006 ◽  
Vol 88 (4) ◽  
pp. 405-407 ◽  
Author(s):  
P Pietzik ◽  
I Qureshi ◽  
J Langdon ◽  
S Molloy ◽  
M Solan
Keyword(s):  
Length Of Stay ◽  
Hospital Stay ◽  
Complication Rate ◽  
Retrospective Review ◽  
Fast Track ◽  
Surgical Intervention ◽  
Length Of Hospital Stay ◽  
Ankle Fractures ◽  
Track System ◽  
Operative Fixation

INTRODUCTION Ankle fractures are common and many require surgical intervention. It has been well documented that a delay in fracture fixation results in increased length of hospital stay and increased complication rate. Initial delay can also allow swelling or blistering to develop which may necessitate a further delay in operative fixation for up to 1 week. The aim of the current study was to review the length of hospital in-patient stay for operative ankle fractures over the previous 12-month period at our hospital and compare this to the length of hospital stay following the introduction of a fast-track system for the fixation of these fractures (all fractures fixed within 48 h). PATIENTS AND METHODS A retrospective review of all ankle fractures managed by open reduction and internal fixation over a 12-month period was undertaken. A protocol was then agreed to openly reduce and fix these fractures at the earliest possible opportunity over the next 6-month period. We then collected the data on all ankle fractures that needed open reduction and internal fixation over this 6-month period. The pre-protocol and post-protocol groups were then compared for total hospital length of stay and complication rate. RESULTS In the 12-month retrospective review, there were 83 ankle fractures that required surgical intervention. Sixty-two of these had surgery within 48 h (mean length of stay, 5.4 days), and 21 had surgery after 48 h (mean length of stay, 9.5 days). There were 39 ankle fractures in the post-protocol group who all had surgery within 48 h (mean length of stay, 5 days). There was no increase in complication rate after implementation of the fast-track system. CONCLUSIONS This study shows that early operative intervention for ankle fractures reduces the length of hospital stay. Intensive physiotherapy and co-ordinated discharge planning are also essential ingredients for early discharge. Early operative fixation for unstable ankle fractures has substantial cost-saving implications with no increase in complication rate.

scholarly journals Effect of Hypoalbuminemia on Perioperative Complications and Hospital Outcomes in Ankle Fracture Fixation

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000
Author(s):  
Collin Barber ◽  
Andrew Chung ◽  
Clifford Jones ◽  
George Russell ◽  
Sean Karr
Keyword(s):  
Length Of Stay ◽  
Serum Albumin ◽  
Fracture Fixation ◽  
Ankle Fracture ◽  
Preoperative Diagnosis ◽  
Perioperative Complications ◽  
Ankle Fractures ◽  
Operative Outcomes ◽  
Surgical Fixation ◽  
Operative Fixation

Category: Trauma Introduction/Purpose: Pre-operative serum albumin levels have routinely been utilized to assess nutritional status. Malnutrition, as defined by serum albumin levels < 3.5 g/dL, has been associated with worse post-operative outcomes in multiple surgical settings. The effect of hypo-albuminemia on 30-day post-operative outcomes after operative fixation of ankle fractures has not been well delineated. Methods: Using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database, 1,526 patients who had undergone surgical fixation of ankle fractures were identified using Current Procedural Terminology (CPT) codes. Perioperative complications and length of hospital stay were compared between patients with and without hypoalbuminemia (serum albumin concentration <3.5 g/dL) with adjustment for patient and procedural factors. Complications were divided into major and minor. Major complications included death, myocardial infarction, sepsis, and return to operating room. Results: Preoperative diagnosis of hypoalbuminemia was present in 324 patients (21%). Multivariate analysis confirmed hypoalbuminemia as an independent risk factor for major complications following surgical fixation of ankle fractures (2.3% vs 7.7%; odds ratio [OR], 2.35; 95% confidence interval [CI], 1.29 to 4.27; p=0.05). Patients with a preoperative diagnosis of hypoalbuminemia had an increased length of stay (p<0.001) and increased risk of rehospitalization (1.9% vs 7.1%; OR 4.072; 2.03 to 8.19, p<0.001) compared to those with normal albumin levels. Conclusion: The presence of hypoalbuminemia upon admission for ankle fracture fixation increases risk of major perioperative complications as well as hospital length of stay. Nutritional optimization of malnourished patients is important in patients undergoing operative fixation of ankle fractures.

scholarly journals Time to surgery for ankle fractures

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0039
Author(s):  
Paul Rai ◽  
Jitendra Mangwani
Keyword(s):  
Venous Thromboembolism ◽  
Soft Tissue ◽  
Ankle Fractures ◽  
Wound Complications ◽  
Soft Tissue Coverage ◽  
Time To Surgery ◽  
Wound Breakdown ◽  
Deep Wound ◽  
Patient Reported ◽  
The Mean

Category: Trauma Introduction/Purpose: Ankle fractures constitute 9% of all fractures and surgical fixation is often required when they are unstable. The bony anatomy has little soft tissue coverage overlying the malleoli. The surgical site is therefore at risk of infection and wound breakdown. BOAST guidelines advise operative fixation on the first or second day after injury. Often in practice this window is missed and fixation is undertaken many days after the injury. We aimed to prospectively review the incidence of early wound complications and infection in 300 patients treated early or late with plate osteosynthesis for Weber B or C ankle fractures. This was conducted at a UK Trauma Unit. Methods: Between November 2013 and November 2016 consecutive patients with closed, isolated ankle fractures were included. Consent was obtained for entry into the study pre-operatively and they were followed up at 2 weeks post operation. Patients were categorised by time to surgery into the following subsets: < 24 hours, < 48 hours and > 48 hours. The 2 week consultation letters were reviewed retrospectively and reported wound complications recorded. The hospital microbiology database was used to identify any positive superficial or deep wound culture results. Comorbidity data and demographics were collected. Results: 208 out of 300 patients had a complete dataset. The mean age was 46 (range 16-95). The superficial infection rate at < 24 hours, < 48 hours and > 48 hours was 4%, 0% and 3% respectively. There were no suspected deep infections at 2 weeks. There were 7 (3%) positive deep wound cultures. The mean BMI was 28 and venous thromboembolism prophylaxis was instituted for all patients as per local guidelines. 3% had diabetes and 23% were smokers. Conclusion: This study has shown that timing of surgery has not shown any significant influence on early infection rates. Surgery may be safely delayed until soft tissue swelling has reduced. However, there may be other benefits of early surgery such as reduced venous thromboembolism and improved patient reported outcome measures.

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

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.

scholarly journals 191. oral versus Intravenous Antibiotic Treatment in Skin and Soft Tissue Infections as a Consequence of Intravenous Drug Use: A Retrospective Study to Demonstrate Noninferiority

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S224-S224
Author(s):  
Aryn M Andrzejewski ◽  
J Alex Viehman
Keyword(s):  
Soft Tissue ◽  
Drug Use ◽  
Length Of Stay ◽  
Oral Therapy ◽  
Statistical Difference ◽  
Treatment Completion ◽  
Intravenous Drug ◽  
Soft Tissue Infections ◽  
Intravenous Drug Use ◽  
Oral Group

Abstract Background Skin and soft tissue infections (SSTIs) are among the most prevalent infectious complications of intravenous drug use (IVDU). Given its polymicrobial nature, studies focusing on SSTIs in the general population may not be generalizable this group. We completed a retrospective chart review to better characterize the safety and efficacy of oral versus intravenous (IV) antibiotics for the treatment SSTIs in IVDU. Methods We reviewed patients admitted with bacterial SSTIs and IVDU from January 01, 2012 to December 31, 2019 based on ICD-10 codes. SSTIs complicated by bacteremia, endocarditis, bone or joint involvement on index admission were excluded. Patients who received &lt; 48 hours of IV antibiotics were considered oral therapy, otherwise they were considered IV therapy. Patient comorbidities, incision and drainage (I&D) status, substance use, microbiology and antimicrobial data were reviewed. Results Of 231 eligible patients, 84 received oral therapy. There was no statistical difference in patient characteristics between the two therapy groups. Streptococcus anginosus group were the most common organisms found (33%) followed by Staphylococcus aureus (31%). There was no statistical difference between rates of readmission (p=0.87), recurrent primary site infection (p=1.00), repeat debridement (p=0.08) or occurrence of deep-seated infections within 90 days of treatment completion. No morality was observed. The oral group had shorter length of stay (3 vs. 5 days, p &lt; 0.001) and shorter total duration of antibiotics (10 vs. 13 days, p &lt; 0.001). Overall, 90% of those with abscess underwent I&D, which did not differ between therapy groups. Time to I&D was shorter (0 vs. 1 day, p=0.005) in the oral group. Patients who did not receive and I&D were more likely to be readmitted within 90 days (p=0.025). Conclusion In SSTIs related to IVDU, oral antibiotic therapy was noninferior to IV in terms of mortality, readmission, and deep-seated infection rates within 90 days of treatment completion and had a decreased length of stay and total treatment duration. A delay in I&D led to increased length of stay and lack of I&D increased readmission rate. Therefore, a prompt I&D may allow a safe and effective early transition to oral therapy in SSTIs related to IVDU. Disclosures All Authors: No reported disclosures

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