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External Fixation in the Emergency Department for Pilon and Unstable Ankle Fractures

Shah, Kalpit N., MD; Johnson, Joey P., MD; O'Donnell, Seth W., MD; Gil, Joseph A., MD; Born, Christopher T., MD; Hayda, Roman A., MD

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: June 15, 2019 - Volume 27 - Issue 12 - p e577–e584
doi: 10.5435/JAAOS-D-18-00080
Research Article

Introduction: Pilon and unstable ankle fractures are often treated initially with an external fixator (ex-fix). Ex-fix application in the emergency department (ED) has been described but not compared with that placed in the operating room (OR).

Methods: Retrospective, case-cohort study was performed at a level-1 trauma center. Using CPT codes, we identified patients who had surgical fixation of pilon or ankle fractures with an initial ex-fix application (in the ED or the OR). Postoperative outcomes and hospital logistical data were compared between the two groups.

Results: Ninety-six patients met the inclusion criteria. The average age of patients was 47 years, and 54 (56%) of the patients were men. Thirty-three patients had the ex-fix placed in the OR, whereas 63 patients had the ex-fix placed in the ED. Postsurgical complications (prominent implant, nonunion, deep infection, deep vein thrombosis, loss of reduction) were seen in 6 of 33 patients in the ED ex-fix group and in 8 of 63 patients in the OR ex-fix group (P = 0.51). Deep infections occurred in 2 of 33 patients in the OR ex-fix group and in 5 of 63 patients in the ED ex-fix group (P = 0.71). Revision ex-fix for loss of reduction was performed in 4 of 33 patients in the OR ex-fix group and in 10 of 63 patients in the ED ex-fix group (P = 0.59). Mean length of stay was 14 days for the OR ex-fix group and 13 days for the ED ex-fix group (P = 0.35).

Conclusion: No statistically significant differences were found in postsurgical complications (surgical or infectious) or ex-fix revision rates for the ED ex-fix group and the OR ex-fix group. Results indicate that uniplanar ex-fix may be safely applied in the ED.

Level of Evidence: Level III, therapeutic

From the Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI.

Correspondence to Dr. Shah: kalpit210@gmail.com

Dr. Johnson or an immediate family member serves as a board member, owner, officer, or committee member of the Orthopaedic Trauma Association. Dr. Born or an immediate family member serves as a paid consultant to Illuminoss, Stryker; serves as an unpaid consultant to BI Medical and BioIntraface; has stock or stock options held in BioIntraface and Illuminoss; has received research or institutional support from Stryker; and serves as a board member, owner, officer, or committee member of AAOS and American College of Surgeons. Dr. Hayda or an immediate family member is a member of a speakers' bureau or has made paid presentations on behalf of AONA and Synthes; serves as an unpaid consultant to BioIntraface; and serves as a board member, owner, officer, or committee member of AAOS, METRC, and Orthopaedic Trauma Association. None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Shah, Dr. O'Donnell, and Dr. Gil.

© 2019 by American Academy of Orthopaedic Surgeons
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