Neuromuscular Electrostimulation Device Reduces Preoperative Edema and Accelerates Readiness for Theater in Patients Requiring Open Reduction Internal Fixation for Acute Ankle Fracture

Abstract

Significant edema manifests as soft tissue swelling that can delay surgery in patients with ankle fractures. Interventions that expedite swelling reduction may yield clinical and economic benefits. This case-control pilot study aimed to assess the ability to recruit ankle fracture patients to a prospective study using a neuromuscular electrostimulation (NMES) device. Device effectiveness, safety, and patient acceptability were also assessed. Prospective evaluation of 20 patients admitted for ankle fracture fixation with the application of NMES device to the skin just below the knee (intervention arm). Participants were matched for baseline demographics and injury descriptors to a historical operative cohort (control arm). The time until the swelling had settled to a level permitting surgery (“readiness for surgery”) was recorded alongside patient tolerability and device acceptance. The mean time until swelling reduced to a level permitting surgery was 1.66 days (NMES) versus 3.66 days (control) (P=0.001). Overall 60% of participants were ready for theater after 2 days of treatment with the NMES device compared with 27% in the control group (P<0.01). Independent health economic modeling of this scenario suggests that the savings associated with this accelerated readiness for theater is £569 per patient. The NMES device is safe and well tolerated by patients with ankle fractures. It is easy to apply, can be worn continuously, and does not restrict patients to their bed space. This study suggests that it is effective in reducing ankle edema and accelerating readiness for theater and may therefore allow earlier surgery and reduced length of stay in this patient group.

Level of Evidence: Diagnostic Level 3. See Instructions for Authors for a complete description of levels of evidence.