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Risk Factors for Revision of External Fixation of Unstable Ankle Injuries
Adam M Schlauch1, Ishan Shah, Benjamin Crawford
1From the San Francisco Orthopaedic Residency Program, San Francisco, California, San Francisco (Dr. Schlauch, Dr. Shah, Dr. Crawford, and Dr. Piple); the East Bay Orthopaedic Trauma and Reconstruction, Castro Valley (Dr. Krosin); and the Alameda Health System, Highland Hospital, Oakland, CA (Dr. Krosin).
Poor reduction quality during external fixation for unstable ankle fractures significantly increases the risk of revision surgery. Surgeons must ensure accurate intraoperative assessment to improve patient outcomes.
Area of Science:
- Orthopaedic Surgery
- Trauma Care
- Skeletal Biomechanics
Background:
- External fixation is a common treatment for unstable ankle injuries.
- Improper technique can lead to complications and necessitate revision surgery.
- Identifying risk factors for revision is crucial for improving patient outcomes.
Purpose of the Study:
- To identify risk factors associated with revision of external fixation in unstable ankle injuries.
- To evaluate the impact of reduction quality on the need for revision surgery.
Main Methods:
- Retrospective cohort study of 120 patients undergoing external fixation for unstable ankle injuries at a level I academic trauma center.
- Exclusion criteria included non-fracture external fixation, inadequate imaging, skeletal immaturity, and short follow-up.
- Primary outcome was revision of external fixation within 30 days.
Main Results:
- Of 97 eligible patients, 18.6% required revision within 30 days.
- Poor intraoperative reduction was associated with a significantly higher revision rate (28%, P < 0.001).
- Increased talar tilt (>0.5°) was identified as an independent risk factor for revision (OR, 22.62).
Conclusions:
- Poor reduction quality during external fixation is a significant risk factor for revision in unstable ankle injuries.
- Surgeons should meticulously assess intraoperative reduction to minimize the need for revision surgery.
- Optimizing reduction quality can improve the success rates of external fixation for ankle fractures.
