Adverse Events and Their Risk Factors Following Intra-articular Corticosteroid Injections of the Ankle or Subtalar Joint.

BACKGROUND: Little data exists regarding the incidence of adverse events and their associated risk factors following intra-articular corticosteroid injection of the ankle and subtalar joint. The aim of this study was to determine the complication rate associated with such injections and to identify any predictive risk factors. METHODS: Adult patients who had received an intra-articular ankle or subtalar joint injection between January 2000 and April 2016 at one of 3 regional hospitals (2 level 1 trauma centers and 1 community hospital) were included. Patients with prior intra-articular injection of corticosteroid into the ankle or subtalar joint were excluded. Explanatory variables were sex, age, race, body mass index, diabetes status, tobacco use, presence of fluoroscopic guidance, location of intra-articular injection, and administering physician's years of experience. RESULTS: Of the 1708 patients included in the final cohort, 99 patients (5.8%) had a total of 104 adverse events within 90 days postinjection. The most prevalent types of adverse events were postinjection flare in 78 patients (4.6% of total cohort, 75% of adverse events) followed by skin reaction in 10 patients (0.6% of total cohort, 9% of adverse events). No infections were noted. Multivariable logistic regression analysis found that intra-articular injection in the subtalar ( P = .004) was independently associated with development of an adverse event. Fluoroscopic guidance was not found to be protective of an adverse event compared to nonguided injections ( P = .476). CONCLUSION: The adverse event rate following intra-articular ankle or subtalar joint corticosteroid injection was 5.8%, with postinjection flare being the most common complication. Infections following injection were not reported. Injection into the subtalar joint was independently associated with the development of an adverse event after intra-articular corticosteroid injection, and this was not mitigated by the use of fluoroscopic guidance. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Postoperative Pain After Surgical Treatment of Ankle Fractures: A Prospective Study.

BACKGROUND: Postoperative pain after fixation of ankle fractures has a substantial effect on surgical outcome and patient satisfaction. Patients requiring large amounts of narcotics are at higher risk of long-term use of pain medications. Few prospective studies investigate patient pain experience in the management of ankle fractures. METHODS: We prospectively evaluated the pain experience in 63 patients undergoing open reduction and internal fixation of ankle. The Short-Form McGill Pain Questionnaire was administered preoperatively and postoperatively (PP) at 3 days (3dPP) and 6 weeks (6wPP). Anticipated postoperative pain (APP) was recorded. RESULTS: No significant differences were found between PP, APP, and 3dPP; however, 6wPP was markedly lower. Significant correlations were found between PP and APP and between preoperative and postoperative Short-Form McGill Pain Questionnaire scores. PP and APP were independent predictors of 3dPP; however, only APP was predictive of 6wPP. Sex, age, and inpatient versus outpatient status were not notable factors. No statistically significant differences were found in pain scores between fracture types. CONCLUSIONS: Both preoperative pain severity and anticipated postoperative pain are predictive of postoperative pain levels. Orthopaedic surgeons should place a greater focus on the postoperative management of patient pain and expectations after surgical procedures.