Published results showed ankle fractures surgically treated by orthopedic surgeons had lower rates of malunion; and nonunion than when treated by podiatrists. Jeremy Y. Chan, MD, Julius A. Bishop, MD, and colleagues categorized 11,745 patients who underwent ankle fracture fixation based; on whether they treated by an orthopedic surgeon or a podiatrist. Researchers used ICD-9 codes to identify complications, including malunion or nonunion, infection; deep vein thrombosis and rates of irrigation and debridement, and CPT codes to identify revision surgeries.
Using the Charlson Comorbidity Index, researchers compared risk factors for complications. Using an insurance claims database, 11,745 patients who underwent ankle fracture fixation between 2007; and 2015 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;; identified by the Current Procedural Terminology codes.
Malunion or nonunion rate
However, complications analyzed included malunion/nonunion, infection; deep vein thrombosis, and rates of irrigation and débridement. Risk factors for complications compared using the Charlson Comorbidity Index. Results showed orthopedic surgeons treated 11,115 patients and podiatrists treated 630 patients. Researchers found a decrease in the percentage of ankle fractures surgically treated by orthopedic surgeons (96.5% to 93%); and an increase in ankle fractures surgically treated by podiatrists from 2007 to 2015 (3.5% to 7%).
Across all types of ankle fractures, patients treated by podiatrists had a malunion; or nonunion rate of 7.3% compared with 4.6% among patients treated by orthopedic surgeons, according to results. Although results showed no differences in complications among patients; with unimalleolar fractures, researchers found patients with bimalleolar; or trimalleolar fractures had higher malunion or nonunion rates when treated by a podiatrist. Researchers noted similar comorbidity profiles; among patients treated by orthopedic surgeons vs. podiatrists.
Ankle fracture surgery
However, surgical treatment of ankle fractures by orthopaedic surgeons 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. However, the 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.
“Despite an increasing number of ankle fracture surgeries being performed by podiatrists in the past decade; our study found that patients who underwent ankle fracture surgery by a podiatric provider were associated with a higher rate of malunion; and nonunion compared to surgeries performed by orthopedic surgeons,” Chan told Healio.com/Orthopedics. “Given the known risks of poor functional outcome; with persistent tibiotalar instability, these findings may have implications for patients who must choose a surgeon to surgically manage their ankle fracture; as well as policymakers who determine scope of practice providers from different educational backgrounds.”