高需求人群踝关节骨折内固定术后的职业结局及恢复跑步情况

Occupational Outcomes and Return to Running Following Internal Fixation of Ankle Fractures in a High-Demand Population.

作者信息

Orr Justin D, Kusnezov Nicholas A, Waterman Brian R, Bader Julia O, Romano David M, Belmont Philip J

机构信息

Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Texas Tech University Health Sciences Center, El Paso, TX, USA

Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Texas Tech University Health Sciences Center, El Paso, TX, USA.

出版信息

Foot Ankle Int. 2015 Jul;36(7):780-6. doi: 10.1177/1071100715575497. Epub 2015 Mar 19.

DOI:10.1177/1071100715575497

PMID:25791034

Abstract

BACKGROUND

Literature evaluating surgical outcomes after ankle fixation in an active patient population is limited. This study determined occupational outcomes and return to running following ankle fracture fixation in a military cohort.

METHODS

All service members undergoing ankle fracture fixation at a single military hospital from August 2007 to August 2012 were reviewed. Univariate analysis determined the association between patient demographic information, type of fracture fixation, and the development of posttraumatic ankle arthritis and functional outcomes, including medical separation, return to running, and reoperation. Seventy-two primary ankle fracture fixation procedures were performed on patients with mean age of 29.1 years. The majority of patients were male (88%), were 25 years of age or older (61%), were of junior rank (57%), underwent unimalleolar fracture fixation (78%), and did not require syndesmotic fixation (54%). The average follow-up was 35.9 months.

RESULTS

The mean time to radiographic union was 8.6 weeks. Twelve service members (17%) were medically separated from the military due to refractory pain following ankle fracture fixation with a minimum of 2-year occupational follow-up. Among military service members undergoing ankle fracture fixation, 64% returned to running. Service members with higher occupational demands had a statistical trend to return to running (odds ratio [OR] 2.49; 95% CI, 0.93-6.68). Junior enlisted rank was a risk factor for medical separation (OR 11.00; 95% CI, 1.34-90.57). Radiographic evidence of posttraumatic ankle osteoarthritis occurred in 8 (11%) service members.

CONCLUSIONS

At mean 3-year follow-up, 83% of service members undergoing ankle fracture fixation remained on active duty or successfully completed their military service, while nearly two-thirds returned to occupationally required daily running.

LEVEL OF EVIDENCE

Level IV, retrospective case series.

摘要

背景

评估活跃患者群体踝关节固定术后手术效果的文献有限。本研究确定了军事队列中踝关节骨折固定术后的职业结局和恢复跑步情况。

方法

回顾了2007年8月至2012年8月在一家军队医院接受踝关节骨折固定术的所有军人。单因素分析确定了患者人口统计学信息、骨折固定类型与创伤后踝关节炎的发生以及功能结局之间的关联，包括医疗退役、恢复跑步和再次手术。对平均年龄为29.1岁的患者进行了72例原发性踝关节骨折固定手术。大多数患者为男性（88%），年龄在25岁及以上（61%），为初级军衔（57%），接受单踝骨折固定（78%），且不需要下胫腓联合固定（54%）。平均随访时间为35.9个月。

结果

影像学愈合的平均时间为8.6周。12名军人（17%）因踝关节骨折固定术后顽固性疼痛而从军队中医疗退役，至少有2年的职业随访。在接受踝关节骨折固定术的军人中，64%恢复了跑步。职业需求较高的军人恢复跑步有统计学趋势（优势比[OR]2.49；95%CI，0.93 - 6.68）。初级入伍军衔是医疗退役的危险因素（OR 11.00；95%CI，1.34 - 90.57）。8名（11%）军人出现创伤后踝骨关节炎的影像学证据。