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Julius A Bishop - One of the best experts on this subject based on the ideXlab platform.

  • icd 10 codes do not accurately reflect Ankle Fracture injury patterns
    Injury-international Journal of The Care of The Injured, 2021
    Co-Authors: Ryan Seltzer, Michael J Gardner, Noelle L Van Rysselberghe, Andrew T Fithian, Christopher M Laprade, Jigyasa Sharma, Yousi A Oquendo, John B Michaud, Malcolm R Debaun, Julius A Bishop
    Abstract:

    Abstract Objective To determine the accuracy of International Classification of Disease Version 10 (ICD-10) coding for Ankle Fracture injury patterns. Design Retrospective cohort study Patients 97 adult patients with Fractures about the Ankle (rotational Ankle Fracture or distal tibia Fracture) from 2016 to 2020, selected by stratified random sampling. Intervention Assignment of an ICD-10 code representative of a rotational Ankle Fracture, pilon Fracture, or unspecified Fracture of the lower leg. Outcome measurements Injury radiographs were reviewed by three authors to determine the correct code. Agreement between the correct code and the electronic medical record (EMR) assigned code was determined using kappa's statistic in the aggregate as well as percent agreement, sensitivity, specificity, and positive predictive value (PPV) between individual codes. Results 59 of 97 cases (60.8%) demonstrated discordance between the existing EMR and surgeon-assigned codes. Aggregate agreement between all codes was fair (K = 0.26). Lateral malleolus Fracture codes demonstrated the highest PPV (0.91, 95% CI 0.72–0.99), while the lowest PPV was found for “other Fractures of the lower leg” (0.05, 95% CI 0.0–0.24) and “other Fracture of the fibula” (0.0, 95% CI 0.0–0.15). Generalized “other Fracture” codes comprised 45% of EMR codes compared to only 6% of assigned codes (p  Conclusion There is substantial discordance between existing EMR and surgeon-assigned ICD-10 codes for Ankle Fractures. Database research that relies on ICD-10 coding as a surrogate for primary clinical data should be interpreted with caution and institutions should make efforts to increase the accuracy of their coding.

  • lower complication rate following Ankle Fracture fixation by orthopaedic surgeons versus podiatrists
    Journal of The American Academy of Orthopaedic Surgeons, 2019
    Co-Authors: Jeremy Y Chan, Jeremy N Truntzer, Michael J Gardner, Julius A Bishop
    Abstract:

    Introduction:Increased overlap in the scope of practice between orthopaedic surgeons and podiatrists has led to increased podiatric treatment of foot and Ankle injuries. However, a paucity of studies exists in the literature comparing orthopaedic and podiatric outcomes following Ankle Fracture fixat

  • lower complication rate following Ankle Fracture fixation by orthopaedic surgeons versus podiatrists
    Foot & Ankle Orthopaedics, 2017
    Co-Authors: Jeremy Y Chan, Jeremy N Truntzer, Michael J Gardner, Julius A Bishop
    Abstract:

    Category:Ankle, TraumaIntroduction/Purpose:Although the scope of practice for orthopaedic surgeons and podiatrists have considerable overlap in many foot and Ankle pathologies, there are significant differences between the training for each surgical specialty that may affect patient outcomes. The purpose of this study was to evaluate complication rates following fixation of Ankle Fractures based on provider type. Our hypothesis was that patients with Ankle Fractures treated by orthopaedic surgeons would have lower complication rates compared to patients treated by podiatrists.Methods:This was a retrospective cohort study of data extracted from the Humana Claims database for 15,067 patients who underwent Ankle Fracture fixation between 2007 and 2015. Procedure type was identified by Current Procedural Terminology (CPT) codes. Patient data was subcategorized by surgeon type (orthopaedic surgeon versus podiatrist) and whether the patient underwent operative treatment for a single malleolus Fracture (CPT 2776...

Jessica Knight - One of the best experts on this subject based on the ideXlab platform.

  • bivalved fiberglass cast compared with plaster splint immobilization for initial management of Ankle Fracture dislocations a treatment algorithm
    Foot and Ankle Specialist, 2012
    Co-Authors: Jeffrey R Baker, Shail N Patel, Adam J Teichman, Summer E S Bochat, Adam E Fleischer, Jessica Knight
    Abstract:

    The initial management of Ankle Fracture-dislocations is the crucial step in the treatment of these emergent traumatic injuries. A stepwise approach is necessary to properly evaluate, diagnose, and treat Ankle Fracture-dislocations. The goal of initial management is to evaluate the vascular status of the extremity and then restore proper alignment of the talus underneath the tibia. A retrospective review was performed on 40 patients, who presented to a community-based hospital emergency room, treated by the foot and Ankle service for Ankle Fracture-dislocation. An analysis of patient demographics, injury pattern/classification, number of reduction attempts, and immobilization method was performed and evaluated. This analysis was correlated with a review of the literature to develop an algorithm for the initial management of Ankle Fracture-dislocations recommending the use of a bivalved below-the-knee fiberglass cast for maintained stabilization post reduction.Level of Evidence: Therapeutic Level IV

  • clinical research bivalved fiberglass cast compared with plaster splint immobilization for initial management of Ankle Fracture dislocations a treatment algorithm
    2012
    Co-Authors: Jeffrey R Baker, Shail N Patel, Adam J Teichman, Adam E Fleischer, Jessica Knight
    Abstract:

    The initial management of Ankle Fracture-dislocations is the crucial step in the treatment of these emergent traumatic injuries. A stepwise approach is necessary to properly evaluate, diagnose, and treat Ankle Fracture- dislocations. The goal of initial management is to evaluate the vascular status of the extremity and then restore proper alignment of the talus underneath the tibia. A retrospective review was performed on 40 patients, who presented to a community-based hospital emergency room, treated by the foot and Ankle service for Ankle Fracture-dislocation. An analysis of patient demographics, injury pattern/classification, number of reduction attempts, and immobilization method was performed and evaluated. This analysis was correlated with a review of the literature to develop an algorithm for the initial management of Ankle Fracture- dislocations recommending the use of a bivalved below- the-knee fiberglass cast for maintained stabilization post reduction.

Nirmal C Tejwani - One of the best experts on this subject based on the ideXlab platform.

  • continuous popliteal sciatic nerve block versus single injection nerve block for Ankle Fracture surgery a prospective randomized comparative trial
    Journal of Orthopaedic Trauma, 2015
    Co-Authors: David Y Ding, Arthur Manoli, David K Galos, Sudheer Jain, Nirmal C Tejwani
    Abstract:

    Objectives To compare rebound pain and the need for narcotic analgesia after Ankle Fracture surgery for patients receiving perioperative analgesia through either a continuous infusion or a single injection nerve block. Design Prospective randomized controlled trial. Settings Surgeries were performed at 2 hospitals affiliated with a large urban academic medical center. Patients/participants Fifty patients undergoing operative fixation of an Ankle Fracture (AO/OTA type 44). Intervention Participants were randomized to receive either a popliteal sciatic nerve block as a single shot (SSB group) or a continuous infusion through an On Q continuous infusion pump (On Q group). Main outcome measurements Visual analog scale and numeric rating scale (0-10) pain levels and amount of pain medication taken. Results For all time points after discharge, mean postoperative pain scores and number of pain pills taken were lower in the On Q group versus the SSB group. Pain scores were significantly lower in the On Q group at the 12 hours postoperative time point (P = 0.002) and at 2 weeks postoperatively. The number of pain pills taken in the first 72 hours was lower in the On Q group (14.9 vs. 20.0; P = 0.036). Overall, 7/23 patients in the On Q group had their pump malfunction and 1 patient accidently removed the catheter. Conclusions Use of continuously infused regional anesthetic for pain control in Ankle Fracture surgery significantly reduces "rebound pain" and the need for oral opioid analgesia compared with single-shot regional anesthetic. Level of evidence Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

  • effect of posterior malleolus Fracture on outcome after unstable Ankle Fracture
    AAOS Annual Meeting, 2010
    Co-Authors: Nirmal C Tejwani, Brian Pahk, Kenneth A Egol
    Abstract:

    Background: The purpose of this article was to compare clinical and functional outcomes of surgically treated trimalleolar Fractures with bimalleolar and unimalleolar Ankle Fractures. Methods: A prospective database was established to enroll all unstable Ankle Fractures treated operatively at our institution from October 2000 to July 2005. Demographic data on 456 patients, who sustained an unstable Fracture of the Ankle and were treated surgically, were entered into a database, and the patients were prospectively followed up. Of these 309 patients who had at least 1-year follow-up, 54 patients sustained an Ankle Fracture with involvement of the posterior malleolus. Two hundred fifty-five patients had an Ankle Fracture without involvement of the posterior malleolus. Of the 54 posterior malleolus Fracture, 20 underwent fixation of the posterior malleolus. All patients were followed up at 3 months, 6 months, and 12 months after surgery and assessed functionally with Short Musculoskeletal Function Assessment and American Orthopaedic Foot and Ankle Society Scores. Results: There was no difference in age, sex distribution, or American society of anesthesiologists classification or incidence of diabetes between the two groups. At 1-year follow-up, all patients improved their function and pain status. Using the American Orthopaedic Foot and Ankle Society, patients with posterior malleolus Fracture were significantly worse both for total score (p = 0.004) and pain function (p = 0.002). At 2-year follow-up, there was no significant difference in a smaller group of patients (41 patients). Using the Short Form-36, there was a significant difference seen with vitality and social function subgroups at 1 year. Using the Short Musculoskeletal Function Assessment, there was a significant difference at 1 year for dysfunction index (p = 0.04) for the trimalleolar group. Conclusion: Most patients after unstable Ankle Fractures treated surgically do well; however, some patients continue to have some pain and dysfunction at 1 year. There was a significant difference in outcomes comparing patients with unstable Ankle Fractures associated with and without posterior malleolus Fractures. The presence of a posterior malleolus Fracture may indicate higher energy of injury, and it does seem to result in worse outcomes at 1 year, but this seems to even out over time as was seen at 2-year follow-up in a smaller group of patients.

  • intra articular block compared with conscious sedation for closed reduction of Ankle Fracture dislocations a prospective randomized trial
    Journal of Bone and Joint Surgery American Volume, 2008
    Co-Authors: Brian J White, Kenneth A Egol, Michael Walsh, Nirmal C Tejwani
    Abstract:

    Background: Ankle Fracture-dislocations require urgent reduction to protect the soft tissues, to minimize articular injury, and to allow swelling to decrease. Conscious sedation is commonly used to provide analgesia for closed reduction of this injury. We hypothesized that an intra-articular block of the Ankle would provide similar analgesia and the ability to reduce the Ankle with a lower risk than conscious sedation. Methods: Between September 2005 and January 2007, forty-two patients with an Ankle Fracture-dislocation presented to our emergency department and were enrolled in a prospective randomized study. The patients were given either conscious sedation or an intra-articular lidocaine block for the reduction and for the application of a plaster splint. After the reduction maneuver, the patients used a visual analog pain scale to rate the level of pain before, during, and after the procedure, from 1 (no pain) to 10 (severe pain). The senior authors reviewed the injury and reduction radiographs to confirm the reduction of the Ankle joint. Results: Twenty-one patients were randomized to each group. There was no difference in demographic data or Fracture patterns between the groups. Both the sedation and the block reduced the pain to a similar degree. The pain reduction (the initial pain level minus the level of pain after medication was given or injected) was an average (and standard deviation) of 4.6 ± 3.3 for the block group and 4.2 ± 3.5 for the sedation group (p = 0.64). The average change in the level of pain between the initial presentation and during the reduction was 3.6 ± 3.8 for the block group and 4.1 ± 3.3 for the sedation group. Overall, there was no difference in analgesia provided by these two methods (p = 0.71). An acceptable reduction was achieved for forty-one of the forty-two patients with one failure in the sedation group. The average time for Ankle reduction and stabilization in a splint was 81.5 minutes for the sedation group and 63.8 minutes for the block group. Conclusions: Compared with conscious sedation, an intra-articular lidocaine block provides a similar degree of analgesia and sufficient analgesia to achieve closed reduction of Ankle Fracture-dislocations. Level of Evidence: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.

Christopher W Digiovanni - One of the best experts on this subject based on the ideXlab platform.

  • arthroscopically assisted versus standard open reduction and internal fixation techniques for the acute Ankle Fracture
    Foot & Ankle International, 2016
    Co-Authors: Tyler Gonzalez, Alec A Macaulay, Lauren K Ehrlichman, Rosa Drummond, Vaishali Mittal, Christopher W Digiovanni
    Abstract:

    Background:Ankle Fractures represent one of the most common orthopaedic injuries requiring operative treatment. Although open reduction and internal fixation (ORIF) of Ankle Fractures leads to good results in most patients, poor functional outcomes continue to be reported in some patients for whom anatomic reduction was achieved. It has been theorized that these lesser outcomes may in part be due to a component of missed intra-articular injury that reportedly ranges between 20% and 79%, although to date the true explanation for this subset of lower functional outcomes remains unknown. Such concerns have recently spawned novel techniques of arthroscopically assisted Ankle Fracture assessment in hopes of enabling better detection and treatment of concomitant intra-articular Ankle injuries. The purpose of this systematic review was to summarize the literature comparing standard ORIF to arthroscopically assisted ORIF (AAORIF) for Ankle Fractures.Methods:A systematic review of the English literature was perfor...

  • Arthroscopically Assisted Versus Standard Open Reduction and Internal Fixation Techniques for the Acute Ankle Fracture.
    Foot & Ankle International, 2015
    Co-Authors: Tyler Gonzalez, Alec A Macaulay, Lauren K Ehrlichman, Rosa Drummond, Vaishali Mittal, Christopher W Digiovanni
    Abstract:

    Background Ankle Fractures represent one of the most common orthopaedic injuries requiring operative treatment. Although open reduction and internal fixation (ORIF) of Ankle Fractures leads to good results in most patients, poor functional outcomes continue to be reported in some patients for whom anatomic reduction was achieved. It has been theorized that these lesser outcomes may in part be due to a component of missed intra-articular injury that reportedly ranges between 20% and 79%, although to date the true explanation for this subset of lower functional outcomes remains unknown. Such concerns have recently spawned novel techniques of arthroscopically assisted Ankle Fracture assessment in hopes of enabling better detection and treatment of concomitant intra-articular Ankle injuries. The purpose of this systematic review was to summarize the literature comparing standard ORIF to arthroscopically assisted ORIF (AAORIF) for Ankle Fractures. Methods A systematic review of the English literature was performed using the PubMed database to access all studies over the last 50 years that have documented the functional outcomes of acute Ankle Fracture management using either a traditional ORIF or an AAORIF technique in the adult population. Relevant publications were analyzed for their respective Levels of Evidence as well as any perceived differences reported in operative time, outcomes, and complications. Results A total of only 14 ORIF and 4 AAORIF papers fit the criteria for review. There is fair quality (grade B) evidence to support good to excellent outcomes following traditional ORIF of malleolar Fractures. There is fair-quality (grade B) evidence that Ankle arthroscopy can be successfully employed for identification and treatment of intra-articular injuries associated with acute Ankle Fractures, but insufficient (grade I) evidence examining the functional outcomes and complication rates after treatment of these injuries and little documentation that this approach portends any improvement in patient outcome over historical techniques. There is also insufficient (grade I) evidence from 2 prospective randomized studies and 1 case-control study to provide any direct comparative data on functional outcomes, complication rates or total operative time between AAORIF and ORIF for the treatment of acute Ankle Fractures. Conclusions Ankle arthroscopy is a valuable tool in identifying and treating intra-articular lesions associated with Ankle Fractures. The presence of such intra-articular pathology may lead to the unexpectedly poor outcomes seen in some patients who undergo surgical fixation of Ankle Fractures with otherwise anatomic reduction on postoperative radiographs; the ability to diagnose and address these lesions therefore has the potential to improve patient outcomes. To date, however, currently available literature has not shown that treatment of these intra-articular injuries provides any improvement in outcomes over standard ORIF, and few prospective randomized controlled studies have been performed comparing these 2 operative techniques-rendering any suggestion that AAORIF improves clinical outcomes over traditional ORIF difficult to justify. Further research is indicated for what may be a potentially promising surgical adjunct before we can advocate its routine use in these patients. Level of evidence Level II, systematic review.

Ann M Moller - One of the best experts on this subject based on the ideXlab platform.

  • rebound pain following peripheral nerve block anaesthesia in acute Ankle Fracture surgery an exploratory pilot study
    Acta Anaesthesiologica Scandinavica, 2019
    Co-Authors: Rune Sort, Stig Brorson, Ismail Gogenur, Jesper K Nielsen, Ann M Moller
    Abstract:

    Background Peripheral nerve blocks (PNB) are increasingly used for anaesthesia and postoperative pain control in acute orthopaedic limb surgery but rebound pain upon cessation of PNBs may challenge the benefits on the pain profile. We aimed to explore the pain profile following acute Ankle Fracture surgery under PNB anaesthesia and investigate if rebound pain could pose a clinical problem. Methods Exploratory, observational study of adults scheduled for acute primary internal fixation of an Ankle Fracture under ultrasound-guided popliteal sciatic and saphenous ropivacaine block anaesthesia. Postoperatively, patients regularly registered pain scores while receiving a fixed analgesics regimen and patient controlled morphine on-demand. We analysed morphine consumption and depicted the detailed pain profiles as graphs allowing for visual analysis of pain courses, including rebound pain. Secondly, we compared the area under the curve and peak pain between relevant age-subgroups. Results We included 21 patients aged 20-83. Depicted pain profiles reveal that PNB supplied effective and long lasting postoperative pain control, but cessation of the PNB led to intense rises in pain scores with six out of nine 20-60-year-olds reaching severe pain levels. The rebound was less pronounced in patients >60 years old, but nearly all reached moderate pain levels. Morphine consumption rates were high during the rebound. Conclusions This study thoroughly analyses the post-PNB pain profile and suggests rebound pain is a clinically relevant and problematic issue with the potential to outweigh the PNB benefits, especially for younger patients. The conclusions are tentative, and a randomised study is pending.

  • peripheral nerve block in Ankle Fracture surgery a qualitative study of patients experiences
    Anaesthesia, 2018
    Co-Authors: M J Henningsen, Rune Sort, Ann M Moller, Suzanne Forsyth Herling
    Abstract:

    Summary Peripheral nerve blocks are popular as a mode of anaesthesia for limb surgery and their beneficial effects are well documented in elective surgery. However, concerns have been raised about potential rebound pain outweighing the benefits in acute Ankle Fracture surgery. Furthermore, pain scores and morphine consumption do not provide a full picture, as pain is subjective. To evaluate the clinical usefulness of peripheral nerve blocks, we explored patients’ expectations and experiences by means of semi-structured interviews analysed with systematic text condensation. We obtained ethical approval and informed consent and sampled purposively among adult patients scheduled for Ankle surgery with nerve blocks as the primary mode of anaesthesia. Patients were interviewed within 48 h postoperatively. Data saturation was reached after 13 interviews. We found that, despite pre-emptive ibuprofen and paracetamol, some patients did experience excruciating rebound pain for up to 2 h, although most had little or no pain. The patients had doubts about what to do when the block wore off, which led to a risk of unnecessary pain levels or morphine overuse. Patients had difficulty understanding the effect and course of the nerve blocks. They had misunderstandings regarding the blocks’ effect on sensation, resulting in fear of feeling pain during surgery and of permanent nerve damage after surgery. However, patients valued the mental alertness, ability to ambulate and efficient pain relief provided by the blocks. We recommend that patients be given thorough and repeated information as we feel this is crucial in preventing undesirable responses from patients, and is likely to increase the overall clinical usefulness of nerve blocks in acute limb surgery.

  • anAnkle trial study protocol a randomised trial comparing pain profiles after peripheral nerve block or spinal anaesthesia for Ankle Fracture surgery
    BMJ Open, 2017
    Co-Authors: Rune Sort, Stig Brorson, Ismail Gogenur, Ann M Moller
    Abstract:

    Introduction Ankle Fracture surgery is a common procedure, but the influence of anaesthesia choice on postoperative pain and quality of recovery is poorly understood. Some authors suggest a benefit of peripheral nerve block (PNB) in elective procedures, but the different pain profile following acute Fracture surgery and the rebound pain on cessation of the PNB both remain unexplored. We present an ongoing randomised study aiming to compare primary PNB anaesthesia with spinal anaesthesia for Ankle Fracture surgery regarding postoperative pain profiles and quality of recovery. Methods and analysis AnAnkle Trial is a randomised, dual-centre, open-label, blinded analysis trial of 150 adult patients undergoing primary internal fixation of an Ankle Fracture. Main exclusion criteria are habitual opioid use, impaired pain sensation, other painful injuries or cognitive impairment. The intervention is ultrasound-guided popliteal sciatic (20 mL) and saphenal nerve (8 mL) PNB with ropivacaine 7.5 mg/mL, and controls receive spinal anaesthesia (2 mL) with hyperbaric bupivacaine 5 mg/mL. Postoperatively all receive paracetamol, ibuprofen and patient-controlled intravenous morphine on demand. Morphine consumption and pain scores are registered in the first 27 hours and reported as an integrated pain score as the primary endpoint. Pain score intervals are 3 hours and we will use the area under curve to get a longitudinal measure of pain. Secondary outcomes include rebound pain on cessation of anaesthesia, opioid side effects (Opioid-Related Symptom Distress Scale), quality of recovery (Danish Quality of Recovery-15 score) and pain scores and medication days 1–7 (diary). Ethics and dissemination The study has been approved by the Regional Ethics Committees in the Capital Region of Denmark, the Danish Data Protection Agency and the Danish Health and Medical Authority. We will publish the results in international peer-reviewed medical journals. Trial registration number AnAnkle Trial is registered in the European Clinical Trials Database (EudraCT 2015-001108-76).