Safety and Outcome Measures of Ankle Open Reduction and Internal Fixation in an Ambulatory Surgical Center.

The transition of traditionally hospital-based orthopedic procedures to the ambulatory surgery center setting provides many benefits from a patient care and financial perspective. Specifically, closed ankle fractures can potentially be managed at such centers without needing hospitalization. Adding to the paucity of data, this study describes the safety, cost, and outcomes of patients undergoing ankle fracture repair in an ambulatory surgery center. A retrospective chart review of 100 patients who underwent ankle fracture open reduction and internal fixation from a single ambulatory surgery center by 1 surgeon were reviewed. Demographic data, surgical characteristics including operating time and cost were collected. Short- and long-term complications, as well as, reoperation rates were reported and functional outcomes were described. Of the 100 patients, 59% were female and the overall average age was 50 ± 16 years. The average cost per case was $8,709.63 ± 6,360.18. The short-term complication rate was 16%, with surgical site infection reported as the most common complication. No postoperative hospital admissions were reported. Planned and unplanned hardware removal was performed in 7% and 5% of patients, respectively. The delayed union rate was 13%, in which 86% shared a history of smoking. Smoking history was the only statistically significant predictor of prolonged bone healing (p = .002). This investigation demonstrates low complications rates for surgeries performed in a surgery center when compared to historical rates of those procedures performed in the hospital. These results suggest that ambulatory surgery center-based ankle fracture repair does not increase complications while may decrease overall cost when compared to ankle ORIF in a hospital setting.

Lesser Metatarsophalangeal Joint Pathology Addressed With Arthrodesis: A Case Series.

Lesser metatarsophalangeal joint pathology is a common condition facing the foot and ankle surgeon, often beginning as a mild subluxation of the toe and progressing to a full dislocation of the metatarsophalangeal joint. In severe or recalcitrant deformities, traditional conservative and surgical methods can fail to resolve the issue. We report on 4 patients with 5 severely dislocated lesser metatarsophalangeal joints with varied etiologies and comorbidities who underwent arthrodesis of these joints using screw and plate fixation. All patients achieved radiographic and clinical signs of union at an average of 16.4 weeks.

Allograft cellular bone matrix as an alternative to autograft in hindfoot and ankle fusion procedures.

This report summarizes the radiographic results of Osteocel Plus in 20 hindfoot and ankle fusions at a single center. The patient population was 40% female with an average age of 57.9 ± 16.1 years. Average body mass index was 33.8 ± 9.1. Risk factors included 3 smokers and 6 patients with diabetes. Primary surgical indications included trauma (50%), Charcot arthropathy (15%), foot drop with osteoarthritis (20%), primary osteoarthritis (10%), and total talar extrusion (5%). Nine patients had a history of prior hindfoot surgery in the same foot; however, only 2 of the cases reported in this series were revisions due to a failed prior surgery; the remaining 7 were treated for correction of a traumatic deformity (n = 5) or diagnosis at a new site in the same foot (n = 2). Treatment included subtalar joint arthrodesis (50%), ankle arthrodesis (40%), triple fusion (5%), and tibial-calcaneal-calcaneal-cuboid arthrodesis (5%). Solid fusion was observed in 100% of patients by the 6-month evaluation. Average time to fusion was 13.5 weeks. Although patients with a prior surgery trended toward a longer time to fusion than patients who underwent their first hindfoot and ankle procedure (14.4 ± 5.3 vs. 12.6 ± 5.7 weeks), the difference was not statistically significant (p = .47). There was no evidence of graft rejection or failure. This series demonstrates that mesenchymal stem cell-based bone allograft is a safe and effective bone-healing material with a high radiographic success rate in foot and ankle arthrodeses with successful and timely fusion rates.