External Fixation in the Emergency Department for Pilon and Unstable Ankle Fractures
| Autor: | Joseph A. Gil, Roman A. Hayda, Joey P. Johnson, Kalpit N. Shah, Christopher T. Born, Seth W OʼDonnell |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male Reoperation Emergency Medical Services medicine.medical_specialty External Fixators Deep vein medicine.medical_treatment Nonunion Ankle Fractures Cohort Studies Young Adult 03 medical and health sciences External fixation Postoperative Complications 0302 clinical medicine Fracture Fixation medicine Humans Orthopedics and Sports Medicine Aged Retrospective Studies Aged 80 and over 030222 orthopedics business.industry Trauma center Retrospective cohort study 030229 sport sciences Emergency department Length of Stay Middle Aged medicine.disease Surgery Tibial Fractures Treatment Outcome medicine.anatomical_structure Case-Control Studies Female Ankle Emergency Service Hospital business Cohort study |
| Zdroj: | Journal of the American Academy of Orthopaedic Surgeons. 27:e577-e584 |
| ISSN: | 1067-151X |
| Popis: | Introduction Pilon and unstable ankle fractures are often treated initially with an external fixator (ex-fix). Ex-fix application in the emergency department (ED) has been described but not compared with that placed in the operating room (OR). Methods Retrospective, case-cohort study was performed at a level-1 trauma center. Using CPT codes, we identified patients who had surgical fixation of pilon or ankle fractures with an initial ex-fix application (in the ED or the OR). Postoperative outcomes and hospital logistical data were compared between the two groups. Results Ninety-six patients met the inclusion criteria. The average age of patients was 47 years, and 54 (56%) of the patients were men. Thirty-three patients had the ex-fix placed in the OR, whereas 63 patients had the ex-fix placed in the ED. Postsurgical complications (prominent implant, nonunion, deep infection, deep vein thrombosis, loss of reduction) were seen in 6 of 33 patients in the ED ex-fix group and in 8 of 63 patients in the OR ex-fix group (P = 0.51). Deep infections occurred in 2 of 33 patients in the OR ex-fix group and in 5 of 63 patients in the ED ex-fix group (P = 0.71). Revision ex-fix for loss of reduction was performed in 4 of 33 patients in the OR ex-fix group and in 10 of 63 patients in the ED ex-fix group (P = 0.59). Mean length of stay was 14 days for the OR ex-fix group and 13 days for the ED ex-fix group (P = 0.35). Conclusion No statistically significant differences were found in postsurgical complications (surgical or infectious) or ex-fix revision rates for the ED ex-fix group and the OR ex-fix group. Results indicate that uniplanar ex-fix may be safely applied in the ED. Level of evidence Level III, therapeutic. |
| Databáze: | OpenAIRE |
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