SLR - November 2016 - Heather Schaefbauer

The Role of Outpatient Visit After Operative Treatment of Ankle Fractures

Reference: Ovaska MT, Nuutinen T, Madanat R, Makinen TJ, Soderlund T. The Role of Outpatient Visit After Operative Treatment of Ankle Fractures. Injury. 2016 Sep. 7

Scientific Literature Review

Reviewed By: Heather Schaefbauer, DPM
Residency Program: HealthPartners Institute/Regions Hospital, St. Paul, MN

Podiatric Relevance:
Ankle fractures are commonly encountered in clinical practice and are among the most frequent fractures treated operatively today. Postoperative complications, such as surgical site infections and issues with wound healing, are commonly encountered. Malreduction leading to reoperation as a postoperative complication is much less common, but despite this fact, postoperative radiographs at early outpatient follow-up visits are still routinely obtained. This article evaluates whether these routine radiographs obtained at early follow-up visits result in a change in patient management.

Methods:
A chart review of 878 patients who underwent operative treatment for ankle fractures with an early (<3 weeks) outpatient clinical and radiological visit. Inclusion criteria included patients who received operative treatment (open reduction and internal fixation) at the primary institution and were 16 years of age or older. A standard operative and postoperative protocol was used during the study period. Demographic data, fracture type (classification, fracture-dislocation, open fracture) and data concerning the first postoperative visit at three weeks was recorded for all patients.

Results:
A total of 86 of the 878 (9.8 percent) patients required a change in treatment plan due to the findings of the first outpatient visit, and 18 of these 86 patients required further operative management. Of the 86 patients, 32 had an unexpected emergency visit prior to their clinical follow-up, and therefore, 54 (6.2 percent) patients required a change in treatment based on findings at their first postoperative visit. Of the 86 patients, 91 percent required a change in management exclusively due to findings based on clinical exam (infection, cast-related problems, etc.). Only three of the 86 patients (0.3 percent) had a change in management based on radiographic findings taken at the first postoperative visit.

Conclusions: The results of the study showed that nearly 10 percent of treated ankle fractures required a change in management or treatment plan and that the far majority of these cases are based on clinical findings (infections, cast-related issues). Only three of the 878 patients in the study required a change in management based on radiographic findings, and therefore, the study concludes that radiographs should not be routinely obtained at the first outpatient follow-up visit. The authors of the study also conclude that although routine radiographs should not be obtained, they still recommend an early follow-up appointment postoperatively based on the level of complications with infections/cast-related issues. 

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