Timing of Early Complications Following Open Reduction and Internal Fixation of Closed Ankle Fractures.

Introduction: There is increasing interest in the early identification and treatment of adverse medical events following orthopaedic procedures. The purpose of this study is to characterize the timing of 8 early adverse events following open reduction and internal fixation of closed fractures of the ankle. Methods: A retrospective cohort study was conducted using the American College of Surgeons National Surgical Quality Improvement Program. A total of 17 318 patients undergoing open reduction and internal fixation of closed ankle fractures were identified. 48.4% of patients were discharged on the day of surgery. For each of 8 different early adverse events, the median postoperative day of diagnosis, interquartile range for day of diagnosis, and middle 80% for day of diagnosis were determined. Timing was compared between unimalleolar and bi-/trimalleolar fractures and between inpatient and outpatient procedures. Results: The median day of diagnosis (and interquartile range; middle 80%) for myocardial infarction was 2 (1-5; 0-17), pneumonia 3 (2-7; 1-19), acute kidney injury 6.5 (2-18; 2-20), urinary tract infection 7 (2-14; 0-24), pulmonary embolism 10 (3-21; 0-27), sepsis 15 (4-22; 1-28), deep vein thrombosis 17 (10-22; 3-27), and surgical site infection 19 (14-25; 8-28). Patients with bi-/trimalleolar fractures had earlier occurrence of myocardial infarction (day 2 vs 10), urinary tract infection (day 6.5 vs 9.5), and sepsis (day 10 vs 20.5). Inpatients had later occurrence of acute kidney injury (day 7 vs 3), but earlier occurrence of urinary tract infection (day 6 vs 15). Conclusions: These precisely described time periods for occurrence of specific adverse events enable heightened awareness among orthopaedic surgeons during the first month following open reduction and internal fixation of the ankle. Orthopaedic surgeons should have the lowest threshold for testing for each adverse event during the time period of greatest risk.Levels of Evidence: Therapeutic, Level III: Retrospective cohort study.

Total Ankle Arthroplasty Is Safer Than Total Hip and Knee Arthroplasty in the Early Postoperative Period.

BACKGROUND: Total hip and knee arthroplasty (THA and TKA) are performed more commonly than total ankle arthroplasty (TAA), so patients and the orthopaedic community are more familiar with the likelihood of complications after THA and TKA than after TAA. The present study places early complication rates after TAA in the context of those after THA and TKA. METHODS: Patients who underwent TAA, THA, or TKA during 2006 to 2016 as part of the National Surgical Quality Improvement Program were identified. Multivariate regression was used to compare procedures with adjustment for baseline and anesthesia characteristics. RESULTS: One hundred thirty-eight thousand three hundred twenty-five patients underwent THA, 223,587 TKA, and 839 TAA. The total complication rate was lower for TAA (2.98%) compared with THA (4.92%, P = 0.011) and TKA (4.56%, P = 0.049). Similarly, the rate of blood transfusion was lower for TAA (0.48%) compared with THA (9.66%) and TKA (6.44%, P < 0.001 for each). The rate of additional surgery was lower for TAA compared with THA (0.48% versus 1.79%, P = 0.007). Finally, the rate of readmission was lower for TAA (1.45%) compared with THA (3.66%, P = 0.002) and TKA (3.40%, P = 0.005). DISCUSSION: Patients can be counseled that relative to THA and TKA, TAA is safer in the perioperative period, with lower rates of adverse events, blood transfusion, additional surgery, and hospital readmission.

Patient Knowledge Regarding Radiation Exposure From Foot and Ankle Imaging.

Foot and ankle surgeons routinely prescribe diagnostic imaging that exposes patients to potentially harmful ionizing radiation. It is unclear how well patients understand the radiation to which they are exposed. In this study, 946 consecutive new patients were surveyed regarding medical imaging and radiation exposure prior to their first appointment. Respondents compared the amount of radiation associated with chest X-rays (CXRs) with various types of foot and ankle imaging. Results were compared with actual values of radiation exposure from the published literature. Of 946 patients surveyed, 841 (88.9%) participated. Most had private insurance (82.8%) and a bachelor's degree or higher (60.6%). Most believed that foot X-ray, ankle X-ray, "low dose" foot and ankle computed tomography (CT) scan (alluding to cone-beam CT), and traditional foot and ankle CT scan contain similar amounts of ionizing radiation to CXR. This contradicts the published literature that suggests that the actual exposure to patients is 0.006, 0.006, 0.127, and 0.833 CXR equivalents of radiation, respectively. Of patients who had undergone an X-ray, 55.9% thought about the issue of radiation prior to the study, whereas 46.1% of those undergoing a CT scan considered radiation prior to the exam. Similarly, 35.2% and 27.6% reported their doctor having discussed radiation with them prior to obtaining an X-ray and CT scan, respectively. Patients greatly overestimate the radiation exposure associated with plain film X-rays and cone-beam CT scans of the foot and ankle, and may benefit from increased counseling regarding the relatively low radiation exposure associated with these imaging modalities.Level of Evidence: Level III: Prospective questionnaire.