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Lower Complication Rate Following Ankle Fracture Fixation by Orthopaedic Surgeons Versus Podiatrists

Chan, Jeremy Y. MD; Truntzer, Jeremy N. MD; Gardner, Michael J. MD; Bishop, Julius A. MD

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: August 15, 2019 - Volume 27 - Issue 16 - p 607–612
doi: 10.5435/JAAOS-D-18-00630
Research Article

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 fixation.

Methods: Using an insurance claims database, 11,745 patients who underwent ankle fracture fixation between 2007 and 2015 were retrospectively evaluated. Patient data were analyzed based on the provider type. Complications were identified by the International Classification of Diseases, Ninth Revision, codes, and revision surgeries were identified by the Current Procedural Terminology codes. Complications analyzed included malunion/nonunion, infection, deep vein thrombosis, and rates of irrigation and débridement. Risk factors for complications were compared using the Charlson Comorbidity Index.

Results: Overall, 11,115 patients were treated by orthopaedic surgeons and 630 patients were treated by podiatrists. From 2007 to 2015, the percentage of ankle fractures surgically treated by podiatrists had increased, whereas that treated by orthopaedic surgeons had decreased. Surgical treatment by podiatrists was associated with higher malunion/nonunion rates among all types of ankle fractures. No differences in complications were observed in patients with unimalleolar fractures. In patients with bimalleolar or trimalleolar fractures, treatment by a podiatrist was associated with higher malunion/nonunion rates. Patients treated by orthopaedic surgeons versus podiatrists had similar comorbidity profiles.

Discussion: Surgical treatment of ankle fractures by orthopaedic surgeons was associated with lower rates of malunion/nonunion when compared with that by podiatrists. The reasons for these differences are likely multifactorial but warrants further investigation. Our findings have important implications in patients who must choose a surgeon to surgically manage their ankle fracture, as well as policymakers who determine the scope of practice.

Level of Evidence: Level III—retrospective cohort study

From the Department of Orthopaedic Surgery, Stanford Health Care, Stanford, CA.

Correspondence to Dr. Chan:

Dr. Gardner or an immediate family member has received IP royalties from Synthes; is a member of a speakers' bureau or has made paid presentations on behalf of KCI; serves as a paid consultant to Biocomposites, BoneSupport AB, Conventus, Globus Medical, KCI, Pacira Pharmaceuticals, SI-Bone, StabilizOrtho, and Synthes; has stock or stock options held in Conventus, Imagen Technologies; has received research or institutional support from Medtronic, SmartDevices, SMV Medical, Synthes, and Zimmer Biomet; and serves as a board member, owner, officer, or committee member of the American Orthopaedic Association, Orthopaedic Research Society, and Orthopaedic Trauma Association. Dr. Bishop or an immediate family member has received IP royalties from Globus Medical and Innomed; serves as a paid consultant to DePuy, Globus Medical, and KCI; has received research or institutional support from Conventus; and serves as a board member, owner, officer, or committee member of the Western Orthopaedic Association. Neither of the following authors nor 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. Chan and Dr. Truntzer.

© 2019 by American Academy of Orthopaedic Surgeons
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