Classification systems for the reporting of surgical complications have been developed and adapted for many surgical subspecialties. The purpose of this systematic review was to examine the variability and frequency of reporting terms used to describe complications in ankle fracture fixation. We hypothesized that the terminology used would be highly variable and inconsistent, corroborating previous results that have suggested a need for standardized reporting terminology in orthopaedics. Ankle fracture outcome studies meeting predetermined inclusion and exclusion criteria were selected for analysis by two independent observers. Terms used to define adverse events were identified and recorded. If a difference occurred between the two observers, a third observer was enlisted. Results of both observers were compared. All terms were then compiled and assessed for variability and frequency of use throughout the studies involved. Reporting terminology was subsequently grouped into 10 categories. In the 48 studies analyzed, 301 unique terms were utilized to describe adverse events. Of these terms, 74.4% (224/301) were found in a single study each. Only one term, “infection”, was present in 50% of studies, and only 19 of 301 terms (6.3%) were used in at least 10% of papers. The category that was most frequently reported was infection, with 89.6% of studies reporting on this type of adverse event using 25 distinct terms. Other categories were “wound healing complications” (72.9% of papers, 38 terms), “bone/joint complications” (66.7% of papers, 35 terms), “hardware/implant complications” (56.3% of papers, 47 terms), “revision” (56.3% of papers, 35 terms), “cartilage/soft tissue injuries” (45.8% of papers, 31 terms), “reduction/alignment issues” (45.8% of papers, 29 terms),“medical complications” (43.8% of papers, 32 terms), “pain” (29.2% of papers, 16 terms) and “other complications” (20.8% of papers, 13 terms). There was a 78.6% interobserver agreement in the identification of adverse terms across the 48 studies included. The reporting terminology utilized to describe adverse events in ankle fracture fixation was found to be highly variable and inconsistent. This variability prevents accurate reporting of adverse events and makes the analysis of potential outcomes difficult. The development of standardized reporting terminology in orthopaedics would be instrumental in addressing these challenges and allow for more accurate and consistent outcomes reporting

Background. The aim of our study was to assess the ability of orthopaedic surgical trainees to adequately assess ankle radiographs following operative fixation of unstable ankle fracture. Methods and results. We identified 26 Supination-External rotation (SER) stage IV fractures, and 4 Pronation-External rotation (PER) stage III fractures treated surgically in our institution. Radiographs were evaluated for shortening of the fibula, widening of the joint space, malrotation of the fibula and widening of the medial clear space. Trainees were shown these radiographs and asked to comment on the adequacy of reduction. They were then given a simple tutorial on assessing adequacy of reduction and asked to reassess these radiographs. The parameters discussed included assessment of medial clear space, drawing of the tibiofibular line, use of the “circle sign” and measurement of the talocrural angle. There was a statistically significant improvement from 64% to 71.4% (P< 0.05) in the radiographs correctly assessed by orthopaedic trainees following a short tutorial on radiographical assessment. Conclusions. Despite the frequency with which junior surgical trainees deal with ankle fractures, there is a lack of awareness on the objective means of adequately assessing ankle fracture fixation. We highlight this deficiency and demonstrate that a short tutorial on radiographic parameters results in improved assessment and better critical analysis of adequacy of reduction following ankle fracture fixation. As with fractures about the wrist, careful assessment of radiographic parameters should be considered standard practice in assessment of adequacy of reduction in fractures about the ankle

Socially deprived patients face significant barriers that reduce their access to care, presenting unique challenges for orthopaedic surgeons. Few studies have investigated the outcomes of surgical fracture care among those socially deprived, despite the increased incidence of fractures, and the inequality of care received in this group. The purpose of this study was to evaluate whether social deprivation impacted the complications and subsequent management of marginalized/homeless patients following ankle fracture surgery.

In this retrospective, population-based cohort study involving 202 hospitals in Ontario, Canada, we evaluated 45,444 patients who underwent open reduction internal fixation for an ankle fracture performed by 710 different surgeons between January 1, 1994, and December 31, 2011. Socioeconomic deprivation was measured for each patient according to their residential location by using the “deprivation” component of the Ontario Marginalization Index (ON-MARG). Multivariable logistic regression models were used to assess the relationship between deprivation and shorter-term outcomes within 1 year (implant removal, repeat ORIF, irrigation and debridement due to infection, and amputation). Multivariable cox proportional hazards (CPH) models were used to assess longer-term outcomes up to 20 years (ankle fusion and ankle arthroplasty).

A higher level of deprivation was associated with an increased risk of I&D (quintile 5 vs. quintile 1: odds ratio (OR) 2.14, 95% confidence interval (CI), 1.25–3.67, p = 0.0054) and amputation (quintile 4 vs. quintile 1: OR 3.56, 95% CI 1.01–12.4, p = 0.0466). It was more common for less deprived patients to have their hardware removed compared to more deprived patients (quintile 5 vs. quintile 1: OR 0.822, 95% CI 0.76–0.888, p < 0.0001). There was no correlation between marginalization and subsequent revision ORIF, ankle fusion, or ankle arthroplasty.

Marginalized patients are at a significantly increased risk of infection and amputation following operatively treated ankle fractures. However, these complications are still extremely rare among this group. Thus, socioeconomic deprivation should not prohibit marginalized patients from receiving operative management for unstable ankle fractures.

Introduction

The primary goal of treatment of an ankle fracture is to obtain a stable anatomic fixation to facilitate early mobilisation and good functional recovery. However, the need for open reduction and internal fixation must be weighed against poor bone quality, compromised soft tissues, patient co-morbidities and potential wound-healing complications.

Introduction

The aim of this study was to compare the results and length of stay of patients of early (within 12 hours) versus conventional (after 48 hours) ankle fixation our hospital.

Introduction. Excessive soft tissue swelling will delay surgery for a proportion of patients admitted with ankle fractures. Surgical and anesthetic teams may waste time assessing patients destined to be cancelled due to swelling. The aim of this investigation was to determine factors associated with cancellation. Methods. Case notes of 87 patients (46 male, 41 female), mean age 43 years (range, 13 to 80) who underwent ankle fracture fixation were retrospectively analysed. 31 of 87 ankles (36%) were unsuitable for day after admission surgery due to swelling. Factors investigated included age, gender, mechanism of injury, fracture configuration and necessity for reduction on arrival in the emergency department due to dislocation; each factor was independently analysed for significance using Fisher's exact test. Results. Ankle fractures associated with a higher energy injury such as sports, falls from height and road traffic accidents were significantly more likely than simple slips to be cancelled due to excess swelling the following morning (p = 0.053). Tri- or bi-malleolar ankle injuries and fracture dislocations requiring manipulation in the emergency department were also significant risk factors for cancellation (p = 0.004 and p = 0.002 respectively). Patients presenting with at least two of these factors demonstrated a 71% probability of cancellation the following day (17 of 87 patients). Presence of three risk factors increased the probability of cancellation to 100% (3 of 87 patients). Conclusion. Cancellation on the day of surgery wastes time and causes patient distress. During busy on-call periods patients with all three risk criteria will almost certainly be too swollen for next day surgery. With the proviso that these fractures are immobilised in an acceptable position, patients could be rested with elevation and rebooked for surgery as opposed to being assessed and subsequently cancelled due to soft tissue swelling the day after injury

Aims

COVID-19 has changed the practice of orthopaedics across the globe. The medical workforce has dealt with this outbreak with varying strategies and adaptations, which are relevant to its field and to the region. As one of the ‘hotspots’ in the UK , the surgical branch of trauma and orthopaedics need strategies to adapt to the ever-changing landscape of COVID-19.