Unrecognized Anterior Compartment Syndrome Following Ankle Fracture Surgery

A 35-year-old male sustained a lateral malleolar fracture while playing football. The fracture was treated by open reduction and internal fixation with a tourniquet. The next day, the patient returned with pain and swelling of the ankle and was admitted again to the hospital with a suspected diagnosis of cellulitis. Ten hours later, the patient developed the symptoms of anterior compartment syndrome. Emergency open fasciotomy of the anterior compartment was performed. The retrospective analysis of the patient’s history was suggestive of a predisposition to an exercise-induced compartment syndrome. We think that exertional increase of the compartmental pressure before the injury and the tourniquet used during surgery contributed together to the development of compartment syndrome. Physicians should be vigilant in identifying the features of compartment syndrome when managing patients injured during a sporting activity. (J Am Podiatr Med Assoc 99(5): 438–442, 2009)

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Acute compartment syndrome of the foot following open reduction and internal fixation of an ankle fracture

Injury ◽

10.1016/j.injury.2015.06.006 ◽

2015 ◽

Vol 46 (10) ◽

pp. 2064-2068 ◽

Cited By ~ 5

Author(s):

David Neilly ◽

Santosh Baliga ◽

Christopher Munro ◽

Andrew Johnston

Keyword(s):

Internal Fixation ◽

Compartment Syndrome ◽

Ankle Fracture ◽

Open Reduction ◽

Acute Compartment Syndrome

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Isolated Anterior Compartment Syndrome After a Bimalleolar-Equivalent Ankle Fracture in a Collegiate Football Player

Sports Health A Multidisciplinary Approach ◽

10.1177/1941738111420527 ◽

2011 ◽

Vol 3 (6) ◽

pp. 560-563

Author(s):

Adam M. Starr ◽

Kenneth G. Swan ◽

Kenneth G. Swan

Keyword(s):

Compartment Syndrome ◽

Sports Medicine ◽

Ankle Fracture ◽

Football Player ◽

Fracture Dislocation ◽

Student Athlete ◽

Anterior Compartment ◽

Medicine Physician ◽

Collegiate Football ◽

Orthopaedic Injuries

Compartment syndrome after an ankle fracture is an extremely rare and potentially devastating event. The authors report a case of an isolated anterior compartment syndrome in a college student athlete who suffered a bimalle olar ankle fracture dislocation. A review of the literature highlights the importance of vigilance when the sports medicine physician and the community orthopaedist are treating these seemingly basic orthopaedic injuries.

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Clinical Outcome of Bimalleolar Ankle Fracture in Patients with Diabetes Mellitus

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00320 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0032

Author(s):

Hong S. Lee ◽

Kiwon Young ◽

Tae-Hoon Park ◽

Hong Seop Lee

Keyword(s):

Diabetes Mellitus ◽

Clinical Outcome ◽

Internal Fixation ◽

Ankle Fracture ◽

Open Reduction ◽

Outcome Analysis ◽

Charcot Arthropathy ◽

Union Rate ◽

Patients With Diabetes ◽

Fracture Surgery

Category: Trauma; Ankle Introduction/Purpose: Diabetes is a risk factor of postoperative complication for fracture surgery. The purpose of this study was to evaluate the clinical outcome of bimalleolar ankle fracture in patients with diabetes mellitus. Methods: Twenty two patients (an average age; 69.3 years, an average HbA1C; 7.6%) with bi-malleolar ankle Fracture received open reduction and internal fixation between March 2013 and January 2019. Complications related to surgery, progression to Charcot arthropathy, presence of nonunion were used for outcome analysis. The patients were followed for an average of 12.1 months. Results: The nonunion rate was 4.5% (1 case over 22 cases). The incidence rate of Charcot arthropathy was 4.5% (1 case over 22 cases). The patient with Charcot arthropathy was conversed to the tibiotalarcalcaneal fusion with retrograde intramedullary nail. No wound infection or soft tissue complications related to surgery was reported. Conclusion: Standard open reduction and internal fixation technique showed high union rate of bimalleolar ankle fracture in patients with diabetes mellitus. The surgeon should be cautious to the Charcot arthropathy when treating ankle fracture with diabetes mellitus.

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Patient pain drawing is a valuable instrument in assessing the causes of exercise-induced leg pain

BMJ Open Sport & Exercise Medicine ◽

10.1136/bmjsem-2017-000262 ◽

2018 ◽

Vol 4 (1) ◽

pp. e000262 ◽

Cited By ~ 3

Author(s):

Kajsa Rennerfelt ◽

Qiuxia Zhang ◽

Jón Karlsson ◽

Jorma Styf

Keyword(s):

Interobserver Agreement ◽

Leg Pain ◽

Intramuscular Pressure ◽

Hospital Visit ◽

Anterior Compartment ◽

Patient Pain ◽

Kappa Value ◽

Exercise Induced ◽

Patient’S History ◽

Test Retest Reliability

AimWe validated patientpain drawing (PPD) in establishing the diagnosis of chronic anterior compartment syndrome (CACS) in patients with exercise-induced leg pain.MethodsThe study comprised 477 consecutive patients, all suspected of having CACS. The diagnosis was based on the patient’s history, a thorough clinical examination and measurements of intramuscular pressure (IMP) following an exercise test. Patients completed a PPD before their hospital visit. Two independent orthopaedic surgeons diagnosed the causes of leg pain based only on the PPD at least 1 year after admission. Based on the results of diagnostic tests, the patients were divided into three groups: CACS (n=79), CACS with comorbidity (n=89) and non-CACS (n=306).ResultsThe sensitivity of the PPD to identify CACS correctly was 67% (observer 1) and 75% (observer 2). The specificity was 65% and 54%, respectively. The interobserver agreement (n=477) was 80%, and the kappa value was 0.55. The interobserver agreement was 77%, and the kappa value was 0.48 among 168 CACS patients with or without comorbidity. The interobserver agreement was 85%, and the kappa value was 0.56 in 79 CACS, and CACS was correctly diagnosed in 79% (observer 1) and 82% (observer 2). The test–retest showed the same results for the two observers, with an intraobserver agreement of 84%, while the test–retest reliability coefficient was 0.7. Comorbidity was found in 53% of CACS patients.ConclusionPPD might be a valuable instrument in diagnosing the causes of exercise-induced leg pain. It is useful in identifying CACS with and without comorbidity.

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Opioid Consumption Patterns and Prolonged Opioid Use Among Opioid-Naïve Ankle Fracture Patients

Foot & Ankle Specialist ◽

10.1177/1938640021992922 ◽

2021 ◽

pp. 193864002199292

Author(s):

Hope Skibicki ◽

Sundeep Saini ◽

Ryan Rogero ◽

Kristen Nicholson ◽

Rachel J. Shakked ◽

...

Keyword(s):

Ankle Fracture ◽

Monitoring Program ◽

Opioid Consumption ◽

Consumption Patterns ◽

Utilization Rate ◽

Opioid Use ◽

Index Procedure ◽

Postoperative Visit ◽

Fracture Surgery

Introduction Previous literature has demonstrated an association between acute opioid exposure and the risk of long-term opioid use. Here, the investigators assess immediate postoperative opioid consumption patterns as well as the incidence of prolonged opioid use among opioid-naïve patients following ankle fracture surgery. Methods Included patients underwent outpatient open reduction and internal fixation of an ankle or tibial plafond fracture over a 1-year period. At patients’ first postoperative visit, opioid pills were counted and standardized to the equivalent number of 5-mg oxycodone pills. Prolonged use was defined as filling a prescription for a controlled substance more than 90 days after the index procedure, tracked by the New Jersey Prescription Drug Monitoring Program up to 1 year postoperatively. Results At the first postoperative visit, 173 patients consumed a median of 24 out of 40 pills prescribed. The initial utilization rate was 60%, and 2736 pills were left unused. In all, 32 (18.7%) patients required a narcotic prescription 90 days after the index procedure. Patients with a self-reported history of depression (P = .11) or diabetes (P = .07) demonstrated marginal correlation with prolonged narcotic use. Conclusion Our study demonstrated that, on average, patients utilize significantly fewer opioid pills than prescribed and that many patient demographics are not significant predictors of continued long-term use following outpatient ankle fracture surgery. Large variations in consumption rates make it difficult for physicians to accurately prescribe and predict prolonged narcotic use. Level of Evidence: Level III

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Spontaneous Non-Traumatic Anterior Compartment Syndrome with Peroneal Neuropathy and Favorable Outcome

Neuropediatrics ◽

10.1055/s-2008-1073035 ◽

1994 ◽

Vol 25 (05) ◽

pp. 268-270 ◽

Cited By ~ 7

Author(s):

A. Sloane ◽

J. Vajsar ◽

R. Laxer ◽

P. Babyn ◽

E. Murphy

Keyword(s):

Compartment Syndrome ◽

Favorable Outcome ◽

Anterior Compartment ◽

Peroneal Neuropathy

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Wound-Healing Issues Following Rotational Ankle Fracture Surgery: Predictors and Local Management Options

Foot & Ankle Specialist ◽

10.1177/1938640018810422 ◽

2018 ◽

Vol 12 (5) ◽

pp. 409-417 ◽

Cited By ~ 1

Author(s):

Hesham Saleh ◽

Sanjit Konda ◽

Adam Driesman ◽

John Stranix ◽

Catherine Ly ◽

...

Keyword(s):

Wound Healing ◽

Ankle Fracture ◽

Wound Complications ◽

Management Options ◽

Original Cohort ◽

Surgical Interventions ◽

Postoperative Wound ◽

Trimalleolar Fractures ◽

Medical Histories ◽

Fracture Surgery

Background. The incidence and risk factors of wound-healing complications following rotational ankle fracture surgery are well documented in the literature. However, there is a paucity regarding management options following these complications. The goal of this study was to provide a descriptive analysis of one surgeon’s experience managing wound complications in patients who have undergone ankle fracture surgery. Methods. A total of 215 patients who were operatively treated for an unstable ankle were retrospectively identified. Patient demographics, medical histories, initial injury characteristics, surgical interventions, and clinical follow-up were collected. Twenty-five of these patients developed postoperative wound problems. Results. Of the original cohort of 215 patients, 25 (11.6%) developed wound-healing complications. Their average age was 53.6 ± 18.0 years; there were 12 males (48.0%). Connective tissue/inflammatory disease (odds ratio [OR] 3.9), cardiovascular disease (OR 3.6), and active smoking (OR 3.3) were associated with an increased likelihood of developing postoperative wound complications. With regard to injuries, open fractures (OR 17.9) had the highest likelihood of developing postoperative complications, followed by type 44-C (OR 2.8) and trimalleolar fractures (OR 2.0). Conclusion. Wound complications following open treatment of ankle fractures occurred with an incidence of 11.6% in this series, of which only about half required operative intervention. A third of wounds were managed by orthopaedics in conjunction with plastic surgery. Levels of Evidence: Level III: Retrospective comparative study

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Trends in Urgent Care Utilization Following Ankle Fracture Fixation

Foot & Ankle International ◽

10.1177/1071100718804178 ◽

2018 ◽

Vol 40 (2) ◽

pp. 218-223 ◽

Cited By ~ 2

Author(s):

Mostafa M. Abousayed ◽

Christopher K. Johnson ◽

Muhammad Moral ◽

Sarah Sternbach ◽

Andrew J. Rosenbaum

Keyword(s):

Psychiatric Disorders ◽

Healthcare System ◽

Ankle Fracture ◽

Univariate Analysis ◽

Care Facility ◽

Urgent Care ◽

Care Utilization ◽

Level Of Evidence ◽

Patients With Diabetes ◽

Fracture Surgery

Background: The Centers for Medicare and Medicaid services (CMS) have implemented initiatives to improve postdischarge care and reduce unnecessary readmissions. Readmissions within 30 days are frequent and represent an economic burden on both patients and the healthcare system. The aim of this study was to evaluate the frequency and causes for urgent care visits within 30 days of discharge after ankle open reduction and internal fixation (ORIF) and determine factors correlated with such visits. Methods: This was a retrospective analysis of prospectively collected data. All patients who underwent ankle ORIF at our institution between July 1, 2016, and June 30, 2017, were included. Patients were identified using Current Procedural Terminology (CPT) codes for ankle ORIF. Patients’ demographics including age, sex, race, body mass index, occupation, insurance payer, and comorbidities were documented. Results: Thirty-five patients (10.51%) had urgent care visits within 30 days of discharge. Patients presented at a mean of 11.8 days after the day of surgery. Sixteen patients (45.71%) had cast/splint-related issues, 7 (20%) presented with pain, and 7 (20%) with increased operative site drainage. Univariate analysis demonstrated a statistically significant association between postoperative urgent care visits and patients with diabetes ( P = .03) or underlying psychiatric disorders ( P = .03). Conclusion: In this population study of patients undergoing ankle fracture surgery, we found that the rate of urgent care visits within 30 days of discharge exceeded the rate of inpatient readmission. Additionally, patients with diabetes and psychiatric disorders were significantly more likely to present to an urgent care facility postoperatively, potentially accounting for increased expenditures of the healthcare system. Level of Evidence: Level III, comparative series.

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