Utilization of a patient management support system in our clinical pathway has been successfully demonstrated to both reduce the length of hospital stay after primary THA, as well as reducing the number of hospital readmissions. While successful in a general patient population, the ability of a patient management support system to reduce readmissions in subsets of high risk THA patients has not been evaluated. We identified all primary THAs performed at a single institution between 2013 and 2015. Patient sex, age at the time of surgery, race, ASA grade, and 120-day readmissions were retrieved from the patient medical record. Similar to previous studies, the patient's home address was used as a proxy for socioeconomic status, with the estimated median income of a given patient being estimated as the median household income for patients of similar ethnicity living within their zip code as reported in the 2014 U.S. Census. A binary regression was used to determine if a model of patient factors (age, sex, race, socioeconomic status, and/or ASA grade) could accurately predict 120-day readmission after primary THA. Age and socioeconomic status were treated as a continuous variable and all other factors were categorical in nature, and the individual effects of each categorical factor on readmissions were also assessed.INTRODUCTION
METHODS
To reduce both operative trauma and wound length in plate osteosynthesis of dislocated WEBER type B fractures of the distal fibula we started using 3 hole one-third tubular „anti-glide“ AO plates in 1996 instead of longer implants. From 1996 to 2001 a total of 72 patients with isolated WEBER type B fractures were treated operatively by using 3 hole one-third „anti-glide“ AO plates. A clinical and radiographic follow-up examination was performed after 38.6 [18–63] months using the original WEBER score. The statistical method to compare our results with previous investigations was Chi-Square-Test according to Pearson (p=0.05). 67 (93.1%) of all patients were without complaints while 3 (4.2%) complained about exercise induced pain and 2 (2.7) reported rest pain. 69 (95.8%) patients showed identical ranges of ankle joint movement, whereas 3 (4.2%) patients had minimal loss of joint function. Radiographically perfect joint configurations were seen in 69 patients while 3 (4.2%)showed grade 1 arthrosis according to BARGON. A total of 68 (94.4%) patients showed very good (n=50) or good (n=18) results according to Weber. In 4 cases the result was not satisfying. This was not significantly different from other investigations with longer implants, but scar length was reduced and duration of after-treatment was signifcantly faster than treatment with longer implants (p<
0.05). It is concluded that operative stabilisation of isolated Weber type B ankle fractures with 3 hole dorsal „anti-glide“ AO plates can be recommended as a safe, convenient, cost-effective and simple alternative to the use of longer implants.
