Potential Benefits of Limited Clinical and Radiographic Follow-up After Surgical Treatment of Ankle Fractures.
Journal
Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews
ISSN: 2474-7661
Titre abrégé: J Am Acad Orthop Surg Glob Res Rev
Pays: United States
ID NLM: 101724868
Informations de publication
Date de publication:
11 05 2021
11 05 2021
Historique:
received:
26
03
2021
accepted:
29
03
2021
entrez:
11
5
2021
pubmed:
12
5
2021
medline:
26
10
2021
Statut:
epublish
Résumé
Ankle fractures are one of the most prevalent musculoskeletal injuries, with a significant number requiring surgical treatment. Postoperative complications requiring additional interventions frequently occur during the early postoperative period. We hypothesize that there is a limited need for routine clinical and radiographic follow-up once the fracture is deemed healed. IRB approval was obtained at four academic trauma centers. A retrospective chart review was done to identify adults with healed unimalleolar and bimalleolar ankle fractures treated surgically with at least 12 months of follow-up. Based on postoperative radiographs, changes in fracture alignment and implant position from radiographic union to final follow-up were documented. The average reimbursement for a final follow-up clinic visit and a set of ankle radiographs were estimated. A total of 140 patients met inclusion criteria. The mean age at injury was 49.5 years, and 67.9% of patients were female. The mean time to healing was 82.2 days (±33.5 days). After radiographic healing, one patient had radiographic changes but was asymptomatic and full weight bearing at their final follow-up. On average, our institution was reimbursed $46 to $49 for a follow-up clinic visit and $364 to $497 for a set of ankle radiographs. Given the average time to healing, there is limited utility in routine radiographic and clinical follow-up beyond 16 weeks in asymptomatic patients. In our series, this would result in a savings of $950 to $1,200 per patient. However, after ankle fractures were deemed healed, 0.7% patients had radiographic evidence of a change in implant position. Documenting this change did not modify the immediate course of fracture treatment. Surgeons will need to balance the need for routine follow-up with the potential economic benefits in reducing costs to the healthcare system.
Identifiants
pubmed: 33974571
doi: 10.5435/JAAOSGlobal-D-21-00074
pii: 01979360-202105000-00009
pmc: PMC8116015
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Orthopaedic Surgeons.
Références
Eur J Trauma Emerg Surg. 2020 Feb;46(1):121-130
pubmed: 30251154
Acta Orthop. 2012 Jun;83(3):276-81
pubmed: 22401675
J Foot Ankle Surg. 2018 Sep - Oct;57(5):957-960
pubmed: 30017422
Acta Orthop Scand. 1986 Feb;57(1):35-7
pubmed: 3083643
J Orthop Trauma. 2016 Jul;30(7):345-52
pubmed: 27045369
Foot Ankle Surg. 2018 Feb;24(1):34-39
pubmed: 29413771
J Hand Surg Am. 2015 Jan;40(1):49-56
pubmed: 25443168
Injury. 2007 Mar;38(3):392
pubmed: 17292901
J Am Acad Orthop Surg. 2013 Dec;21(12):727-38
pubmed: 24292929
J Orthop Trauma. 2010 Mar;24 Suppl 1:S76-80
pubmed: 20182242
J Orthop Trauma. 2016 Mar;30(3):e100-5
pubmed: 26569187
Acta Orthop Scand. 1987 Oct;58(5):539-44
pubmed: 3425285
Foot Ankle Int. 2015 Oct;36(10):1196-201
pubmed: 25998149
J Foot Ankle Surg. 2014 Sep-Oct;53(5):606-8
pubmed: 24785202
Injury. 1999 Dec;30(10):699-701
pubmed: 10707246
J Orthop Trauma. 2014 Sep;28(9):538-41
pubmed: 24375274
Acta Orthop Scand. 1998 Feb;69(1):48-50
pubmed: 9524518
PLoS One. 2015 Feb 19;10(2):e0118320
pubmed: 25695796
J Am Acad Orthop Surg. 2019 Jun 1;27(11):405-409
pubmed: 30285986
Acta Orthop Scand. 1998 Feb;69(1):43-7
pubmed: 9524517